Provider Demographics
NPI:1053301697
Name:ISMAIL, YOUNUS M (MD)
Entity Type:Individual
Prefix:DR
First Name:YOUNUS
Middle Name:M
Last Name:ISMAIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 S BROAD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-2667
Mailing Address - Country:US
Mailing Address - Phone:256-259-3778
Mailing Address - Fax:256-259-3759
Practice Address - Street 1:1508 S BROAD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2667
Practice Address - Country:US
Practice Address - Phone:256-259-3778
Practice Address - Fax:256-259-3759
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22123207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000041078Medicaid
AL510-41078OtherBLUE CROSS
AL110178240OtherRAILROAD MEDICARE
AL510-41078OtherBLUE CROSS
AL000041078Medicare PIN