Provider Demographics
NPI:1104232065
Name:DAWOD, YASER T (MD)
Entity type:Individual
Prefix:DR
First Name:YASER
Middle Name:T
Last Name:DAWOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:17177 N LAUREL PARK DR STE 439
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3938
Mailing Address - Country:US
Mailing Address - Phone:734-462-0340
Mailing Address - Fax:734-462-0344
Practice Address - Street 1:6255 INKSTER RD STE 307
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2538
Practice Address - Country:US
Practice Address - Phone:734-525-0319
Practice Address - Fax:734-525-7227
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101267285207R00000X, 208M00000X
IAMD-44402207R00000X, 208M00000X
MI4301508379207RC0200X, 207RP1001X
WI74874-20207RC0200X
CA191856208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100202619Medicaid