Provider Demographics
NPI:1184097701
Name:YOUKHANA, RITA (PA-C)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:YOUKHANA
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:13636 DIX TOLEDO RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2432
Mailing Address - Country:US
Mailing Address - Phone:734-283-8121
Mailing Address - Fax:734-589-2838
Practice Address - Street 1:30581 STEPHENSON HWY
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1610
Practice Address - Country:US
Practice Address - Phone:248-589-1770
Practice Address - Fax:248-589-2838
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2016-09-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601007700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant