Provider Demographics
NPI:1083677546
Name:YOUSIF I. HAMATI, M.D., PLC
Entity Type:Organization
Organization Name:YOUSIF I. HAMATI, M.D., PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEMA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:231-733-1326
Mailing Address - Street 1:1440 E SHERMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1878
Mailing Address - Country:US
Mailing Address - Phone:231-733-1326
Mailing Address - Fax:231-830-2764
Practice Address - Street 1:1440 E SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1878
Practice Address - Country:US
Practice Address - Phone:231-733-1326
Practice Address - Fax:231-830-2764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301036132207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1790000Medicaid
MI4301036132OtherSTATE LICENSE
0613766Medicare PIN
A77583Medicare UPIN