Basic Information
| Provider Information | |||||||||
| NPI: | 1386610764 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YOUNES | ||||||||
| FirstName: | WASSIM | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD, RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1213 MASON ST | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481242841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132782800 | ||||||||
| FaxNumber: | 3132780030 | ||||||||
| Practice Location | |||||||||
| Address1: | 1213 MASON ST | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481242841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132782800 | ||||||||
| FaxNumber: | 3132780030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 08/13/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301082559 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 183500000X | 5302030359 | MI | N | Pharmacy Service Providers | Pharmacist |
ID Information
| ID | Type | State | Issuer | Description | 4870203 | 05 | MI | MEDICAID | 1108267571 | 01 | MI | BCN | OTHER | 1108267571 | 01 | MI | BCBS | OTHER | P00363393 | 01 | MI | MEDICARE RAILROAD | OTHER |