Provider Demographics
NPI:1922413327
Name:SALAH, YUSUF
Entity Type:Individual
Prefix:
First Name:YUSUF
Middle Name:
Last Name:SALAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7557 W 92ND ST APT 201
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60455-2197
Mailing Address - Country:US
Mailing Address - Phone:708-296-0230
Mailing Address - Fax:630-326-2200
Practice Address - Street 1:1513 NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-3737
Practice Address - Country:US
Practice Address - Phone:630-733-8775
Practice Address - Fax:630-326-2200
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2018-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361452632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-145263Medicaid