Individual
DR. ETHAN YUSSIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1611 NW 12TH AVE, MIAMI, FL 33136-1005
(305) 585-1111
Mailing address
3619 NE 207TH STREET, APT#2202, AVENTURA, FL 33180
(786) 280-5252
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
TRN10600
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TRN10600
TRAINING LICENSE
FL
Enumeration date
06/06/2007
Last updated
07/08/2007
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