Provider Demographics
NPI:1548245509
Name:YUSUFJI, AKHTAR E (MD)
Entity Type:Individual
Prefix:
First Name:AKHTAR
Middle Name:E
Last Name:YUSUFJI
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:PO BOX 1193
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42419-1193
Mailing Address - Country:US
Mailing Address - Phone:270-827-4003
Mailing Address - Fax:270-827-4146
Practice Address - Street 1:110 3RD ST
Practice Address - Street 2:SUITE 250
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2993
Practice Address - Country:US
Practice Address - Phone:270-827-4002
Practice Address - Fax:270-827-4146
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16643208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64166432Medicaid
KY64166432Medicaid
KY1241401Medicare ID - Type Unspecified