Provider Demographics
NPI:1548280464
Name:MOOSA, YUNUS ALI (MD)
Entity type:Individual
Prefix:
First Name:YUNUS
Middle Name:ALI
Last Name:MOOSA
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 1:1370 N INTERSTATE DR
Mailing Address - Street 2:SUITE 154
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-3376
Mailing Address - Country:US
Mailing Address - Phone:918-421-6079
Mailing Address - Fax:918-421-6077
Practice Address - Street 1:300 S 8TH ST STE 182W
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2444
Practice Address - Country:US
Practice Address - Phone:270-762-1560
Practice Address - Fax:270-752-2861
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2022-10-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA200765207RC0000X, 207RI0011X
WAMD 60408489207RC0000X, 207RI0011X
TXP4487207RC0000X, 207RI0011X
OK23782207RI0011X
ORMD212821207RI0011X
KY46683207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1584436Medicaid
LAP00390466OtherRR MEDICARE
WA2017560Medicaid
LA5CE22Medicare PIN