MEDICARE: GEORGES S YACOUB MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	35080325	OH
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	35080325	OH
3	207RS0012X	Sleep Medicine (Internal Medicine) Physician	35080325	OH
4	208M00000X	Hospitalist Physician	35080325	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487659041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGES S YACOUB MD

Provider Business Mailing Address
First Line	:	PO BOX 1013
Second Line	:	3006 N. CO RD 25A STE 102
City	:	TROY
State	:	OH
Zip	:	45373-8013
Country	:	US
Telephone Number	:	937-335-2075
Fax Number	:	937-339-0612

Provider Business Practice Location Address
First Line	:	3006 N. CO. RD 25A STE 102
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-1373
Country	:	US
Telephone Number	:	937-335-2075
Fax Number	:	937-335-9840

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	04/12/2013

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Directions to “ GEORGES S YACOUB MD” Practice Location

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