Provider Demographics
NPI:1376698498
Name:YOUSEFI, YOUHANA (MD)
Entity type:Individual
Prefix:
First Name:YOUHANA
Middle Name:
Last Name:YOUSEFI
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 1:7447 W TALCOTT
Mailing Address - Street 2:SUITE #331
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631
Mailing Address - Country:US
Mailing Address - Phone:773-792-1882
Mailing Address - Fax:773-792-0881
Practice Address - Street 1:7447 W TALCOTT
Practice Address - Street 2:SUITE #331
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631
Practice Address - Country:US
Practice Address - Phone:773-792-1882
Practice Address - Fax:773-792-0881
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL17657208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036046400Medicaid
G53588Medicare UPIN