1972763613 NPI number — HASSAN H YOUSSEF MD SC

Table of content: DR. MARILYN LIMFUECO DUBAN M.D. (NPI 1902875982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972763613 NPI number — HASSAN H YOUSSEF MD SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HASSAN H YOUSSEF MD SC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972763613
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 S KENNEDY DR
Provider Second Line Business Mailing Address:
STE 900
Provider Business Mailing Address City Name:
BRADLEY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60915-2682
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-932-3132
Provider Business Mailing Address Fax Number:
815-932-2397

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 S KENNEDY DR
Provider Second Line Business Practice Location Address:
STE 900
Provider Business Practice Location Address City Name:
BRADLEY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60915-2682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-932-3132
Provider Business Practice Location Address Fax Number:
815-932-2397
Provider Enumeration Date:
06/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WORKMAN
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
815-932-3132

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  036-081606 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 036081606 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com