Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | FT001 | KY |
NPI | 1003481615 |
---|---|
Provider Name | Tarek El-Gammal Yousif |
First Address | Louisville, KY 40202-1858 |
Second Address | Louisville, KY 40202-1858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2021 |
Last Update Date | 25/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
FT001 | STATE LICENSE (01) | KY |