Provider Demographics
NPI:1881643088
Name:YOUSUF, SHUJA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHUJA
Middle Name:
Last Name:YOUSUF
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 1:348 CROSSGATES BLVD STE 1300
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2687
Mailing Address - Country:US
Mailing Address - Phone:601-825-5000
Mailing Address - Fax:
Practice Address - Street 1:348 CROSSGATES BLVD STE 1300
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2687
Practice Address - Country:US
Practice Address - Phone:601-825-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17986207R00000X, 207P00000X, 207RG0100X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03572035Medicaid
MS267687YNFEMedicare PIN
MS03572035Medicaid
MSH79183Medicare UPIN