Provider Demographics
NPI:1134884216
Name:MOHAMED, YUSUF ISMAIL
Entity type:Individual
Prefix:
First Name:YUSUF
Middle Name:ISMAIL
Last Name:MOHAMED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4635 S 20TH ST APT 108
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2857
Mailing Address - Country:US
Mailing Address - Phone:414-502-4022
Mailing Address - Fax:
Practice Address - Street 1:8050 S WILDWOOD DR APT 103
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-7410
Practice Address - Country:US
Practice Address - Phone:414-502-4022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver