Provider Demographics
NPI:1710191143
Name:YACOUB, NINOS (MD)
Entity Type:Individual
Prefix:DR
First Name:NINOS
Middle Name:
Last Name:YACOUB
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 1:15075 LINCOLN ST
Mailing Address - Street 2:APT. 846
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-3335
Mailing Address - Country:US
Mailing Address - Phone:586-943-7619
Mailing Address - Fax:248-849-5389
Practice Address - Street 1:21090 ALLEN RD
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-1602
Practice Address - Country:US
Practice Address - Phone:734-676-9800
Practice Address - Fax:734-676-9801
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084397207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine