Basic Information
| Provider Information | |||||||||
| NPI: | 1609047281 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EBRAHIM | ||||||||
| FirstName: | YOUSUF | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 CHESHIRE LN N | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554463706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883339152 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5953 W PARK AVE | ||||||||
| Address2: | |||||||||
| City: | HOUMA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703641450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858769076 | ||||||||
| FaxNumber: | 9858769191 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2008 | ||||||||
| LastUpdateDate: | 03/21/2008 | ||||||||
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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 | 237700000X | 1024 | LA | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.