Provider Demographics
NPI: | 1003185653 |
---|---|
Name: | YOUSIF GORIEL MD,PC |
Entity Type: | Organization |
Organization Name: | YOUSIF GORIEL MD,PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | YOUSIF |
Authorized Official - Middle Name: | HANNA |
Authorized Official - Last Name: | GORIEL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 248-968-9500 |
Mailing Address - Street 1: | 15351 W 9 MILE RD |
Mailing Address - Street 2: | |
Mailing Address - City: | OAK PARK |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48237-2514 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 248-968-9500 |
Mailing Address - Fax: | 248-968-9502 |
Practice Address - Street 1: | 15351 W 9 MILE RD |
Practice Address - Street 2: | |
Practice Address - City: | OAK PARK |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48237-2514 |
Practice Address - Country: | US |
Practice Address - Phone: | 248-968-9500 |
Practice Address - Fax: | 248-968-9502 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-12-27 |
Last Update Date: | 2011-12-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | 4301034445 | 208600000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Single Specialty |