Provider Demographics
NPI:1003893462
Name:HUSSAIN, MIR TAJAMMUL (MD)
Entity Type:Individual
Prefix:
First Name:MIR
Middle Name:TAJAMMUL
Last Name:HUSSAIN
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 1:6720 BERTNER AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2604
Mailing Address - Country:US
Mailing Address - Phone:832-355-2666
Mailing Address - Fax:
Practice Address - Street 1:6720 BERTNER AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2604
Practice Address - Country:US
Practice Address - Phone:832-355-2666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0284207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX050075369OtherRAILROAD
TX118185101Medicaid
TX118185109Medicaid
TX8A0490OtherBLUE CROSS BLUE SHILED
TX8EH271OtherBCBS TX
TX118185105Medicaid
TX118185106Medicaid
TX118185108Medicaid
TX118185107Medicaid
G97216Medicare UPIN
TX118185107Medicaid
TX118185106Medicaid
TX118185109Medicaid
TX118185108Medicaid
TX118185105Medicaid
TX8B4343Medicare PIN
TX8A0490OtherBLUE CROSS BLUE SHILED
TX118185101Medicaid