Provider Demographics
NPI:1174595763
Name:YOUSUF, KABIR A (MD)
Entity type:Individual
Prefix:DR
First Name:KABIR
Middle Name:A
Last Name:YOUSUF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 746652
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6652
Mailing Address - Country:US
Mailing Address - Phone:904-720-0599
Mailing Address - Fax:904-376-4036
Practice Address - Street 1:1747 BAPTIST CLAY DR STE 320
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-8503
Practice Address - Country:US
Practice Address - Phone:904-224-5185
Practice Address - Fax:904-278-7284
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MED65777207R00000X
MDD0065777207RC0000X
FLME159189207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD100811100Medicaid