Provider Demographics
NPI:1770580334
Name:GHALY, YOUSSEF B (MD)
Entity type:Individual
Prefix:DR
First Name:YOUSSEF
Middle Name:B
Last Name:GHALY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSEPH
Other - Middle Name:B
Other - Last Name:GHALY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:ST LUKES REGIONAL HEALTH CARE PLC
Mailing Address - Street 2:6030 S FLORIDA AVENUE, SUITE 110
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813
Mailing Address - Country:US
Mailing Address - Phone:863-644-9800
Mailing Address - Fax:863-644-9822
Practice Address - Street 1:6030 S FLORIDA AVE STE 110
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3351
Practice Address - Country:US
Practice Address - Phone:863-644-9800
Practice Address - Fax:863-644-9822
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-82770207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2626292-00Medicaid
FL2626292-00Medicaid
FL06246ZMedicare PIN