Provider Demographics
NPI:1841249760
Name:A. HAJYOUSEF, MD PC
Entity type:Organization
Organization Name:A. HAJYOUSEF, MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDASSALAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAJYOUSEF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-263-6733
Mailing Address - Street 1:901 KIMOLE LN
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1491
Mailing Address - Country:US
Mailing Address - Phone:517-263-6733
Mailing Address - Fax:517-263-7148
Practice Address - Street 1:901 KIMOLE LN
Practice Address - Street 2:SUITE B-1
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1491
Practice Address - Country:US
Practice Address - Phone:517-263-6733
Practice Address - Fax:517-263-7148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI350D676100OtherBCBSM