Healthcare Provider Details

I. General information

NPI: 1376698498
Provider Name (Legal Business Name): YOUHANA YOUSEFI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7447 W TALCOTT SUITE #331
CHICAGO IL
60631
US

IV. Provider business mailing address

7447 W TALCOTT SUITE #331
CHICAGO IL
60631
US

V. Phone/Fax

Practice location:
  • Phone: 773-792-1882
  • Fax: 773-792-0881
Mailing address:
  • Phone: 773-792-1882
  • Fax: 773-792-0881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17657
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: