Provider Demographics
NPI:1578070496
Name:IBRAHIM, YUSUF OLUSESAN
Entity Type:Individual
Prefix:MR
First Name:YUSUF
Middle Name:OLUSESAN
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7308 DONNELL PL APT D1
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-4241
Mailing Address - Country:US
Mailing Address - Phone:240-716-8999
Mailing Address - Fax:
Practice Address - Street 1:7308 DONNELL PL APT D1
Practice Address - Street 2:
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-4241
Practice Address - Country:US
Practice Address - Phone:240-716-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-30
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13354374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI-165-967-660-242OtherDRIVER LICENCE