Provider Demographics
NPI:1447297551
Name:YASSIR, WALID KHALED (MD)
Entity type:Individual
Prefix:DR
First Name:WALID
Middle Name:KHALED
Last Name:YASSIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3901 BEAUBIEN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2119
Mailing Address - Country:US
Mailing Address - Phone:313-745-8147
Mailing Address - Fax:
Practice Address - Street 1:3901 BEAUBIEN ST FL 1
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2119
Practice Address - Country:US
Practice Address - Phone:313-745-5227
Practice Address - Fax:313-745-5596
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301091249207XP3100X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAH46844Medicare UPIN
MIP35120062Medicare PIN