Provider Demographics
NPI:1386610764
Name:YOUNES, WASSIM M (MD, RPH)
Entity type:Individual
Prefix:
First Name:WASSIM
Middle Name:M
Last Name:YOUNES
Suffix:
Gender:M
Credentials:MD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 MASON ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2841
Mailing Address - Country:US
Mailing Address - Phone:313-278-2800
Mailing Address - Fax:313-278-0030
Practice Address - Street 1:1213 MASON ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2841
Practice Address - Country:US
Practice Address - Phone:313-278-2800
Practice Address - Fax:313-278-0030
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301082559207R00000X
MI5302030359183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4870203Medicaid
MI1108267571OtherBCN
MI1108267571OtherBCBS
MIP00363393OtherMEDICARE RAILROAD
MII53305Medicare UPIN
MI4870203Medicaid