Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 4301504450 | MI |
NPI | 1003303058 |
---|---|
Provider Name | Simon Yousif |
First Address | Shelby Township, MI 48316-3842 |
Second Address | Detroit, MI 48201-2153 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2018 |
Last Update Date | 20/05/2021 |