Provider Demographics
NPI:1043569361
Name:NACKOUD, YAMEN (MD)
Entity Type:Individual
Prefix:DR
First Name:YAMEN
Middle Name:
Last Name:NACKOUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 BUTTERNUT AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3203
Mailing Address - Country:US
Mailing Address - Phone:818-486-1511
Mailing Address - Fax:
Practice Address - Street 1:715 BUTTERNUT AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-3203
Practice Address - Country:US
Practice Address - Phone:818-486-1511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301101536207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine