Provider Demographics
NPI:1013248764
Name:PERVEZ YUSAF M.D.,P.C.
Entity Type:Organization
Organization Name:PERVEZ YUSAF M.D.,P.C.
Other - Org Name:PERVEZ YUSAF MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PERVEZ
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSAF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-799-1350
Mailing Address - Street 1:5275 COLONY DR N
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-7157
Mailing Address - Country:US
Mailing Address - Phone:989-799-1350
Mailing Address - Fax:989-799-6833
Practice Address - Street 1:5275 COLONY DR N
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-7157
Practice Address - Country:US
Practice Address - Phone:989-799-1350
Practice Address - Fax:989-799-6833
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERVEZ YUSAF MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301038356261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1099090Medicaid
MI1194881011OtherNPI 1
MI0730155Medicare PIN
MI1099090Medicaid