Provider Demographics
NPI:1508004094
Name:YASIN, MUHAMMAD (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:
Last Name:YASIN
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 1:100 W MARKET ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1332
Mailing Address - Country:US
Mailing Address - Phone:502-587-8000
Mailing Address - Fax:502-583-8001
Practice Address - Street 1:100 W MARKET ST
Practice Address - Street 2:SUITE 2
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1332
Practice Address - Country:US
Practice Address - Phone:502-587-8000
Practice Address - Fax:502-583-8001
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45105207R00000X, 207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100208060Medicaid
IN201215180Medicaid
KY7100208060Medicaid