Provider Demographics
NPI:1932304219
Name:YAQUB, KASHIF (RPT)
Entity Type:Individual
Prefix:
First Name:KASHIF
Middle Name:
Last Name:YAQUB
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22260 GREEN HILL RD # 5
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-4374
Mailing Address - Country:US
Mailing Address - Phone:248-682-6627
Mailing Address - Fax:248-889-7534
Practice Address - Street 1:1396 SCOTT LAKE RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-1578
Practice Address - Country:US
Practice Address - Phone:248-682-6627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKY012346225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIKY012346OtherSTATE LICENSE