Basic Information
Provider Information
NPI: 1891272381
EntityType: 2
ReplacementNPI:  
OrganizationName: MAGDI YOUNAN MD LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 568
Address2:  
City: MUNCIE
State: IN
PostalCode: 473080568
CountryCode: US
TelephoneNumber: 7652840493
FaxNumber: 7652842434
Practice Location
Address1: 1620 S CONGRESS AVE STE 100
Address2:  
City: PALM SPRINGS
State: FL
PostalCode: 334612128
CountryCode: US
TelephoneNumber: 5619687111
FaxNumber: 7652842434
Other Information
ProviderEnumerationDate: 07/26/2018
LastUpdateDate: 07/26/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: YOUNAN
AuthorizedOfficialFirstName: MAGDI
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: OWNER/AUTHORIZED OFFICIAL
AuthorizedOfficialTelephone: 3176269169
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


Home