Healthcare Provider Details

I. General information

NPI: 1134301773
Provider Name (Legal Business Name): YAZEN JOUDEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 08/09/2025
Certification Date: 08/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16501 106TH CT
ORLAND PARK IL
60467-4522
US

IV. Provider business mailing address

16501 106TH CT
ORLAND PARK IL
60467-4522
US

V. Phone/Fax

Practice location:
  • Phone: 708-904-4979
  • Fax: 708-407-9006
Mailing address:
  • Phone: 708-904-4979
  • Fax: 708-407-9006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036124274
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036124274
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: