Provider Demographics
NPI:1588705032
Name:YUSUF-SAFAVI, YASMIN (MD)
Entity type:Individual
Prefix:
First Name:YASMIN
Middle Name:
Last Name:YUSUF-SAFAVI
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 1:1421 S PARK ST
Mailing Address - Street 2:SUITE#5
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-2178
Mailing Address - Country:US
Mailing Address - Phone:608-957-3000
Mailing Address - Fax:
Practice Address - Street 1:1421 S PARK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-2178
Practice Address - Country:US
Practice Address - Phone:608-443-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43432-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1588705032Medicaid