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General NPI Number Information
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NPI Number | 1720078629
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Entity Type | Individual
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Provider Name | HISHAM T YOUSSEF MD RADIOLOGIST
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Gender | Male
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Dates
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Enumeration Date | 10/24/2005
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Last Update Date | 04/02/2018
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Provider Practice Location Address
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Address Line | 112 E CLARK ST
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City | HARRISBURG
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State | IL
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Zip | 62946-2703
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Country | US
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Telephone | 618-252-8337
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Fax | 618-252-8338
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Provider Business Mailing Address
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Address Line | 112 E CLARK ST PO BOX 265
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City | HARRISBURG
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State | IL
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Zip | 62946-2703
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Country | US
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Telephone | 618-926-5808
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Fax | 618-252-8338
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 336-051265 036089504
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License Number State | IL
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