Provider Demographics
NPI:1720078629
Name:YOUSSEF, HISHAM T (MD RADIOLOGIST)
Entity type:Individual
Prefix:MR
First Name:HISHAM
Middle Name:T
Last Name:YOUSSEF
Suffix:
Gender:M
Credentials:MD RADIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:112 E CLARK ST
Mailing Address - Street 2:PO BOX 265
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-2703
Mailing Address - Country:US
Mailing Address - Phone:618-926-5808
Mailing Address - Fax:618-252-8338
Practice Address - Street 1:112 E CLARK ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946-2703
Practice Address - Country:US
Practice Address - Phone:618-252-8337
Practice Address - Fax:618-252-8338
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336-051265 0360895042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089504Medicaid
IL1720078629OtherNPI
IL1720078629OtherNPI
ILK46347Medicare PIN
240860Medicare ID - Type Unspecified
606020OtherPROV