Provider Demographics
NPI:1487686275
Name:YOUSUF, MOHAMMED (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
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 1:4430 HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3310
Mailing Address - Country:US
Mailing Address - Phone:985-626-3470
Mailing Address - Fax:985-674-5377
Practice Address - Street 1:4430 HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3310
Practice Address - Country:US
Practice Address - Phone:985-626-3470
Practice Address - Fax:985-674-5377
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11006R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA23269OtherCONTROLLED SUBSTANCE #
LA1652539Medicaid
LA1652539Medicaid
LA5U995Medicare PIN
LA23269OtherCONTROLLED SUBSTANCE #