Provider Demographics
NPI:1487659041
Name:YACOUB, GEORGES S (MD)
Entity type:Individual
Prefix:
First Name:GEORGES
Middle Name:S
Last Name:YACOUB
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:PO BOX 1013
Mailing Address - Street 2:3006 N. CO RD 25A STE 102
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-8013
Mailing Address - Country:US
Mailing Address - Phone:937-335-2075
Mailing Address - Fax:937-339-0612
Practice Address - Street 1:3006 N. CO. RD 25A STE 102
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1373
Practice Address - Country:US
Practice Address - Phone:937-335-2075
Practice Address - Fax:937-335-9840
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080325207RP1001X, 207RC0200X, 207RS0012X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2352298Medicaid
OH2352298Medicaid
OHG01087Medicare UPIN
4063974Medicare PIN
OH4063971Medicare ID - Type Unspecified