Provider Demographics
NPI:1306912696
Name:SAHUL, YASMIN (MD)
Entity type:Individual
Prefix:
First Name:YASMIN
Middle Name:
Last Name:SAHUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YASMIN
Other - Middle Name:
Other - Last Name:SAHUL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:210 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:HARBOR BEACH
Mailing Address - State:MI
Mailing Address - Zip Code:48441-1236
Mailing Address - Country:US
Mailing Address - Phone:989-479-3291
Mailing Address - Fax:989-479-3365
Practice Address - Street 1:8970 SAND BEACH RD
Practice Address - Street 2:
Practice Address - City:HARBOR BEACH
Practice Address - State:MI
Practice Address - Zip Code:48441-9324
Practice Address - Country:US
Practice Address - Phone:989-479-3291
Practice Address - Fax:989-479-3365
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075119207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4573460Medicaid
MIH72788Medicare UPIN
MI4573460Medicaid
MI0N86040Medicare ID - Type Unspecified