Basic Information
| Provider Information | |||||||||
| NPI: | 1497839203 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOHAMMAD | ||||||||
| FirstName: | YOUSEF | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1654 UPHAM DR | ||||||||
| Address2: | 430 MEANS HALL | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432101250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142936872 | ||||||||
| FaxNumber: | 6142934688 | ||||||||
| Practice Location | |||||||||
| Address1: | 456 W 10TH AVE | ||||||||
| Address2: | STE 1C | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432101240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142936382 | ||||||||
| FaxNumber: | 6142934724 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 174400000X | 35 07 9708 | OH | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 2266195 | 05 | OH | MEDICAID |