Provider Demographics
NPI:1386615607
Name:MOHAMMED, YOUSUF (MD)
Entity type:Individual
Prefix:
First Name:YOUSUF
Middle Name:
Last Name:MOHAMMED
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 1:1000 REMINGTON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:630-914-2469
Practice Address - Street 1:410 E LINCOLN HWY STE 251
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451
Practice Address - Country:US
Practice Address - Phone:815-485-2541
Practice Address - Fax:815-838-2656
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036111264207Q00000X
IN01060197A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200509140Medicaid
IN217230EEMedicare ID - Type Unspecified
IN200509140Medicaid