Provider Demographics
NPI:1982803532
Name:YACOUB, EMAD N (MD)
Entity type:Individual
Prefix:
First Name:EMAD
Middle Name:N
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 1:40946 US HIGHWAY 19 N # 101
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-5446
Mailing Address - Country:US
Mailing Address - Phone:813-720-7237
Mailing Address - Fax:888-366-6019
Practice Address - Street 1:40946 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-5446
Practice Address - Country:US
Practice Address - Phone:813-720-7237
Practice Address - Fax:888-366-6013
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3106292085R0202X
FLME1017192085R0202X
IL036.1462122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000583100Medicaid
FL50772OtherFL BLUE
FLAU618Medicare PIN