Provider Demographics
NPI:1588155329
Name:YOUSUF, MOHAMMED IBBAD (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:IBBAD
Last Name:YOUSUF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:IBBAD
Other - Middle Name:MOHAMMED
Other - Last Name:YOUSUF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:14335 HESPERIA ROAD, STE 114 PMB 1015
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5794
Mailing Address - Country:US
Mailing Address - Phone:414-877-8763
Mailing Address - Fax:760-243-2909
Practice Address - Street 1:10625 W NORTH AVE STE 101B
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2315
Practice Address - Country:US
Practice Address - Phone:414-727-9183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312451207P00000X
NY390200000X
CAA175436207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program