Provider Demographics
NPI:1043957087
Name:YOUSIF, ROBY N (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBY
Middle Name:N
Last Name:YOUSIF
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4203 ANGELINE DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5004
Mailing Address - Country:US
Mailing Address - Phone:248-462-9958
Mailing Address - Fax:
Practice Address - Street 1:23455 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1908
Practice Address - Country:US
Practice Address - Phone:734-333-8001
Practice Address - Fax:734-333-8002
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601011139363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant