MEDICARE: NIDA YOUSEF MD

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	2080P0202X	Pediatric Cardiology Physician	036124580	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036124580	OTHER	IL	ILLINOIS LICENSE NUMBER

General Provider Information

NPI Number	:	1780883876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIDA YOUSEF MD

Provider Business Mailing Address
First Line	:	4700 W 95TH ST STE 206
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-2574
Country	:	US
Telephone Number	:	708-745-3499
Fax Number	:	708-745-3398

Provider Business Practice Location Address
First Line	:	4700 W 95TH ST STE 206
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-2574
Country	:	US
Telephone Number	:	708-745-3499
Fax Number	:	708-745-3398

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

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	09/06/2025

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