Basic Information
| Provider Information | |||||||||
| NPI: | 1578518304 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WASSIM YOUNES MD PLC | ||||||||
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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: | 05/23/2006 | ||||||||
| LastUpdateDate: | 12/17/2012 | ||||||||
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| AuthorizedOfficialLastName: | YOUNES | ||||||||
| AuthorizedOfficialFirstName: | WASSIM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5866043444 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301082559 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110H232210 | 01 | MI | BCBS | OTHER | 110H232210 | 01 | MI | BCN | OTHER | 4870203 | 05 | MI | MEDICAID | 500H232210 | 01 | MI | BCBS GROUP | OTHER | 110H205700 | 01 | MI | BCBS GROUP | OTHER | 110H205700 | 01 | MI | BCN GROUP | OTHER | DF4170 | 01 | MI | MEDICARE RAILROAD | OTHER |