Provider Demographics
NPI:1154095800
Name:SOUTH SUBURBAN MULTI SPECIALTY GROUP LTD
Entity Type:Organization
Organization Name:SOUTH SUBURBAN MULTI SPECIALTY GROUP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HANAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:YOUSIF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-535-3300
Mailing Address - Street 1:10749 CHERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-3701
Mailing Address - Country:US
Mailing Address - Phone:708-535-3300
Mailing Address - Fax:
Practice Address - Street 1:6300 159TH ST STE C
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-2779
Practice Address - Country:US
Practice Address - Phone:708-535-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty