Provider Demographics
NPI:1417096199
Name:YOUSUF, KHALID MOHAMMED (MD)
Entity Type:Individual
Prefix:DR
First Name:KHALID
Middle Name:MOHAMMED
Last Name:YOUSUF
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 1:4716 ALLIANCE BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5378
Mailing Address - Country:US
Mailing Address - Phone:469-800-7200
Mailing Address - Fax:630-351-8503
Practice Address - Street 1:4716 ALLIANCE BLVD STE 600
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5378
Practice Address - Country:US
Practice Address - Phone:469-800-7200
Practice Address - Fax:630-351-8503
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-129883207X00000X, 207X00000X
MN54647207X00000X
MN105403207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
209398OtherGROUP MEDICARE PTAN
MN200003135Medicare PIN