Active NPI
Ninos Yacoub, M.D.
- Family Medicine Physician
- Woodhaven, MI
National Provider Identifier
1710191143
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 4301084397
- Practice address
- 21090 Allen Rd
Woodhaven, MI 48183-1602 - Phone
- (734) 676-9800
- Fax
- (734) 676-9801
- NPI assigned
- May 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4301084397 | MI | Primary |
Addresses
Primary practice location
21090 Allen Rd
Woodhaven, MI 48183-1602
Mailing address
15075 Lincoln St
Apt. 846
Oak Park, MI 48237-3335
Phone (586) 943-7619
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301084397 | MI | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710191143",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15075 LINCOLN ST",
"address_2": "APT. 846",
"city": "OAK PARK",
"state": "MI",
"postal_code": "482373335",
"telephone_number": "586-943-7619",
"fax_number": "248-849-5389"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21090 ALLEN RD",
"city": "WOODHAVEN",
"state": "MI",
"postal_code": "481831602",
"telephone_number": "734-676-9800",
"fax_number": "734-676-9801"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YACOUB",
"first_name": "NINOS",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "4301084397",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodhaven, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.