Provider Demographics
NPI:1275544058
Name:SENLAMAI, YONGYUTH (MD)
Entity Type:Individual
Prefix:
First Name:YONGYUTH
Middle Name:
Last Name:SENLAMAI
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 1:3413 MCDOUGALL AVENUE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207
Mailing Address - Country:US
Mailing Address - Phone:313-568-1010
Mailing Address - Fax:313-568-1559
Practice Address - Street 1:3413 MCDOUGALL AVENUE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207
Practice Address - Country:US
Practice Address - Phone:313-568-1010
Practice Address - Fax:313-568-1559
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301031580207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2121990Medicaid
0822226Medicare ID - Type Unspecified
A76929Medicare UPIN