Basic Information
| Provider Information | |||||||||
| NPI: | 1104091982 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | YUSUF | ||||||||
| FirstName: | BUSHRA | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16620 N US HIGHWAY 281 | ||||||||
| Address2: | STE 300 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782322679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105674700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5620 LONE STAR PKWY # 2 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782532202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104037978 | ||||||||
| FaxNumber: | 2106800206 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2008 | ||||||||
| LastUpdateDate: | 07/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RN0300X | Q0390 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 352672502 | 01 | TX | CSHCN | OTHER | 352672501 | 05 | TX | MEDICAID |