Provider Demographics
NPI:1578518304
Name:WASSIM YOUNES MD PLC
Entity Type:Organization
Organization Name:WASSIM YOUNES MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WASSIM
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-604-3444
Mailing Address - Street 1:1213 MASON ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2841
Mailing Address - Country:US
Mailing Address - Phone:313-278-2800
Mailing Address - Fax:313-278-0030
Practice Address - Street 1:1213 MASON ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2841
Practice Address - Country:US
Practice Address - Phone:313-278-2800
Practice Address - Fax:313-278-0030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301082559207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110H232210OtherBCBS
MI110H232210OtherBCN
MI4870203Medicaid
MI500H232210OtherBCBS GROUP
MI110H205700OtherBCBS GROUP
MI110H205700OtherBCN GROUP
MIDF4170OtherMEDICARE RAILROAD
MI110H232210OtherBCBS
MI0P32730Medicare PIN