Provider Demographics
NPI:1700238714
Name:MICHAEL, YOUSTINA (MD)
Entity Type:Individual
Prefix:
First Name:YOUSTINA
Middle Name:
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 ROBERTS ST N APT 208
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-4599
Mailing Address - Country:US
Mailing Address - Phone:201-688-9434
Mailing Address - Fax:
Practice Address - Street 1:408 ROBERTS ST N APT 208
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4599
Practice Address - Country:US
Practice Address - Phone:201-688-9434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRL14089207R00000X
ND15698208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine