Provider Demographics
NPI:1437501723
Name:FAHMY, YUSUF (DMD)
Entity Type:Individual
Prefix:DR
First Name:YUSUF
Middle Name:
Last Name:FAHMY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6414A CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46324-1207
Mailing Address - Country:US
Mailing Address - Phone:219-803-6165
Mailing Address - Fax:
Practice Address - Street 1:6414A CALUMET AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46324-1207
Practice Address - Country:US
Practice Address - Phone:219-803-6165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2021-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019030794122300000X
IN12013610A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019030794Medicaid