Provider Demographics
NPI:1962157362
Name:YOUSEF, AMAL A
Entity type:Individual
Prefix:
First Name:AMAL
Middle Name:A
Last Name:YOUSEF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15208 ROYAL FOXHUNT RD
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3843
Mailing Address - Country:US
Mailing Address - Phone:708-267-6736
Mailing Address - Fax:
Practice Address - Street 1:15208 ROYAL FOXHUNT RD
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3843
Practice Address - Country:US
Practice Address - Phone:708-267-6736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver