Provider Demographics
NPI:1285695858
Name:TAWFIK, YOUSSEF (MD)
Entity type:Individual
Prefix:DR
First Name:YOUSSEF
Middle Name:
Last Name:TAWFIK
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 1:555 BELL ROAD
Mailing Address - Street 2:ANBA ABRAAM MEDICAL CLINIC
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013
Mailing Address - Country:US
Mailing Address - Phone:615-365-9994
Mailing Address - Fax:615-365-3443
Practice Address - Street 1:555 BELL RD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-2001
Practice Address - Country:US
Practice Address - Phone:615-365-9994
Practice Address - Fax:615-365-3443
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600750207R00000X
TN44D2033773291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
10341117166OtherPTAN NUMBER
TN4314797OtherBCBS PROVIDER NUMBER
1409706OtherUHC PROVIDER NUMBER
TN1610088OtherAMERIGROUP PROVIDER NUMBER
TN1525906Medicaid
TN4314797OtherBCBS PROVIDER NUMBER