Provider Demographics
NPI:1104641042
Name:YESUF, INDRIS AHMED (MD)
Entity type:Individual
Prefix:
First Name:INDRIS
Middle Name:AHMED
Last Name:YESUF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 SW 100TH ST APT 119
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-3733
Mailing Address - Country:US
Mailing Address - Phone:202-948-9383
Mailing Address - Fax:
Practice Address - Street 1:3020 S UNION AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-3317
Practice Address - Country:US
Practice Address - Phone:253-844-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-16
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMDCE.ML.61628349207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine