Provider Demographics
NPI:1659433506
Name:JOUGH, YOUNG C (MD)
Entity Type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:C
Last Name:JOUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 E NORTH WATER ST
Mailing Address - Street 2:UNIT # 904
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5594
Mailing Address - Country:US
Mailing Address - Phone:312-832-0115
Mailing Address - Fax:
Practice Address - Street 1:2320 E 93RD ST
Practice Address - Street 2:PHYSICAL MEDICINE DEPARTMENT
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-3983
Practice Address - Country:US
Practice Address - Phone:773-967-5221
Practice Address - Fax:773-967-5972
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
283X00000X
IL282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered283X00000XHospitalsRehabilitation Hospital
Not Answered282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
39732Medicare UPIN