Provider Demographics
NPI:1457681512
Name:AFFILIATED INTERNISTS LLC
Entity Type:Organization
Organization Name:AFFILIATED INTERNISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGES
Authorized Official - Middle Name:S
Authorized Official - Last Name:YACOUB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-335-9998
Mailing Address - Street 1:PO BOX 363
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-0363
Mailing Address - Country:US
Mailing Address - Phone:937-339-9030
Mailing Address - Fax:937-339-9723
Practice Address - Street 1:1330 N COUNTY ROAD 25A STE A
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1374
Practice Address - Country:US
Practice Address - Phone:937-339-9030
Practice Address - Fax:937-339-9723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty