1003195645 NPI number — DR. RAID SAID MOUSA YOUSEF M.D.

Table of content: DR. NICOLE OMOTUNDE ETTI PHARM.D (NPI 1194054957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003195645 NPI number — DR. RAID SAID MOUSA YOUSEF M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUSEF
Provider First Name:
RAID SAID MOUSA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003195645
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 DELAWARE ST SE
Provider Second Line Business Mailing Address:
MMC 11
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55455-0341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-625-7911
Provider Business Mailing Address Fax Number:
612-626-0439

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 DELAWARE ST SE
Provider Second Line Business Practice Location Address:
MMC 11
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55455-0341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-625-7911
Provider Business Practice Location Address Fax Number:
612-626-0439
Provider Enumeration Date:
08/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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