MEDICARE: MR. HISHAM T YOUSSEF MD RADIOLOGIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	336-051265 036089504	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1720078629	OTHER	IL	NPI

General Provider Information

NPI Number	:	1720078629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HISHAM T YOUSSEF MD RADIOLOGIST

Provider Business Mailing Address
First Line	:	112 E CLARK ST
Second Line	:	PO BOX 265
City	:	HARRISBURG
State	:	IL
Zip	:	62946-2703
Country	:	US
Telephone Number	:	618-926-5808
Fax Number	:	618-252-8338

Provider Business Practice Location Address
First Line	:	112 E CLARK ST
Second Line	:
City	:	HARRISBURG
State	:	IL
Zip	:	62946-2703
Country	:	US
Telephone Number	:	618-252-8337
Fax Number	:	618-252-8338

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	01/16/2026

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