Provider Demographics
NPI:1851900096
Name:YOUSSEF DERBALA
Entity Type:Organization
Organization Name:YOUSSEF DERBALA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:YOUSSEF
Authorized Official - Middle Name:
Authorized Official - Last Name:DERBALA
Authorized Official - Suffix:
Authorized Official - Credentials:MDQ
Authorized Official - Phone:616-676-6196
Mailing Address - Street 1:15050 E JEFFERSON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-2050
Mailing Address - Country:US
Mailing Address - Phone:248-938-0141
Mailing Address - Fax:
Practice Address - Street 1:15050 E JEFFERSON AVE STE 102
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE PARK
Practice Address - State:MI
Practice Address - Zip Code:48230-2050
Practice Address - Country:US
Practice Address - Phone:248-938-0141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty