Provider Demographics
NPI:1396800868
Name:YOUSUF-ALI, SHEIKH M (MD)
Entity type:Individual
Prefix:
First Name:SHEIKH
Middle Name:M
Last Name:YOUSUF-ALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SHEIKH
Other - Middle Name:M
Other - Last Name:YOUSUF-ALI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:515 NORTH RIDGEFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-2557
Mailing Address - Country:US
Mailing Address - Phone:203-334-7654
Mailing Address - Fax:203-334-2501
Practice Address - Street 1:515 NORTH RIDGEFIELD AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-2557
Practice Address - Country:US
Practice Address - Phone:203-334-7654
Practice Address - Fax:203-334-2501
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT016566207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001165661Medicaid
060000079Medicare ID - Type Unspecified
CT060000079Medicare PIN
D77018Medicare UPIN
CT001165661Medicaid