Provider Demographics
NPI:1699487280
Name:YOUSUF, OSMAN AHMED SR
Entity type:Individual
Prefix:
First Name:OSMAN
Middle Name:AHMED
Last Name:YOUSUF
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 MCKENNA BLVD APT 407
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-2274
Mailing Address - Country:US
Mailing Address - Phone:206-816-0103
Mailing Address - Fax:
Practice Address - Street 1:1218 MCKENNA BLVD APT 407
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-2274
Practice Address - Country:US
Practice Address - Phone:206-816-0103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Single Specialty