Provider Demographics
NPI:1093817603
Name:HUSSAIN, RAYA H (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYA
Middle Name:H
Last Name:HUSSAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10066 DIX
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1551
Mailing Address - Country:US
Mailing Address - Phone:313-849-4949
Mailing Address - Fax:313-849-0469
Practice Address - Street 1:10066 DIX
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1551
Practice Address - Country:US
Practice Address - Phone:313-849-4949
Practice Address - Fax:313-849-0469
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRH065327207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4182420Medicaid
MI383512406OtherFED TAX ID
MI1108272632OtherBCBS
MI4182420Medicaid
MIG86077Medicare UPIN