Provider Demographics
NPI:1386698942
Name:YACOUB, NEVINE RAMSIS (MD)
Entity type:Individual
Prefix:DR
First Name:NEVINE
Middle Name:RAMSIS
Last Name:YACOUB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6308 8TH AVE
Mailing Address - Street 2:ATTN: MEDICAL STAFF OFFICE
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-5031
Mailing Address - Country:US
Mailing Address - Phone:262-653-5300
Mailing Address - Fax:262-656-2963
Practice Address - Street 1:6308 8TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-5031
Practice Address - Country:US
Practice Address - Phone:262-653-5300
Practice Address - Fax:262-656-2963
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50978-20207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34984800Medicaid
ILR00276Medicare PIN
I53959Medicare UPIN
WI34984800Medicaid