Provider Demographics
NPI:1518028281
Name:YASSIN, MAHMOUD A (MD)
Entity Type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:A
Last Name:YASSIN
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 1:501 W MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROBINSON
Mailing Address - State:IL
Mailing Address - Zip Code:62454-1310
Mailing Address - Country:US
Mailing Address - Phone:618-546-5211
Mailing Address - Fax:618-544-2316
Practice Address - Street 1:501 W MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:ROBINSON
Practice Address - State:IL
Practice Address - Zip Code:62454-1310
Practice Address - Country:US
Practice Address - Phone:618-546-5211
Practice Address - Fax:618-544-2316
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine