Basic Information
| Provider Information | |||||||||
| NPI: | 1265482574 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | YUSUF | ||||||||
| FirstName: | MOHAMMAD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2112 NAPLES LN | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405131815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8599480309 | ||||||||
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| Practice Location | |||||||||
| Address1: | 148 LONDON MOUNTAIN VIEW DR | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | LONDON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407416601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068781181 | ||||||||
| FaxNumber: | 6068781267 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 05/11/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 33446 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207P00000X | 33446 | KY | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000380450 | 01 | KY | BCBS PROVIDER NUMBER | OTHER | 64343460 | 05 | KY | MEDICAID | P00616384 | 01 | KY | MEDICARE RAILROAD | OTHER |