Provider Demographics
NPI:1922059559
Name:KABBANI, YOUSSEF MOHAMMED (DPM)
Entity Type:Individual
Prefix:
First Name:YOUSSEF
Middle Name:MOHAMMED
Last Name:KABBANI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 GERMANTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19133-1635
Mailing Address - Country:US
Mailing Address - Phone:267-625-4312
Mailing Address - Fax:215-229-7954
Practice Address - Street 1:2516 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133-1635
Practice Address - Country:US
Practice Address - Phone:267-625-4312
Practice Address - Fax:215-229-7954
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003242L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012857380008Medicaid
PAU29555Medicare UPIN
PA715840Medicare ID - Type UnspecifiedMEDICARE ID NUMBER