Provider Demographics
NPI:1417983222
Name:YOUSEFPOUR, MAKABIS (DPM)
Entity type:Individual
Prefix:DR
First Name:MAKABIS
Middle Name:
Last Name:YOUSEFPOUR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-2655
Mailing Address - Country:US
Mailing Address - Phone:660-562-7999
Mailing Address - Fax:660-562-7996
Practice Address - Street 1:2016 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-2655
Practice Address - Country:US
Practice Address - Phone:660-562-7999
Practice Address - Fax:660-562-7996
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1986213ES0103X
CAE4609213ES0103X
MO2024022221213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX324566401Medicaid
TX324566402Medicaid
TXP01242890OtherRAILROAD MEDICARE
TX313635YUM7Medicare PIN
TXP01242890OtherRAILROAD MEDICARE
CAE4609Medicare ID - Type Unspecified
TX313635YPREMedicare PIN
CAV05722Medicare UPIN
TX313635YPT7Medicare PIN
CA5501590001Medicare NSC