Provider Demographics
NPI:1124042288
Name:YOUSIF, NASHWAN Y (MD)
Entity Type:Individual
Prefix:DR
First Name:NASHWAN
Middle Name:Y
Last Name:YOUSIF
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:PO BOX 4304
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-4304
Mailing Address - Country:US
Mailing Address - Phone:248-693-8634
Mailing Address - Fax:
Practice Address - Street 1:940 W AVON RD
Practice Address - Street 2:STE 7
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2760
Practice Address - Country:US
Practice Address - Phone:248-693-8634
Practice Address - Fax:248-693-8644
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080432207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4909513-10Medicaid
MI4985103-10Medicaid
MI0P34720Medicare PIN
MII57846Medicare UPIN
MIP28070090Medicare PIN