Provider Demographics
NPI:1114916202
Name:HUSSAIN, TANVEER (MD)
Entity Type:Individual
Prefix:
First Name:TANVEER
Middle Name:
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 1:6935 TREELINE DR
Mailing Address - Street 2:SUITE J
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-3393
Mailing Address - Country:US
Mailing Address - Phone:440-746-2220
Mailing Address - Fax:440-746-3496
Practice Address - Street 1:2351 E 22ND ST
Practice Address - Street 2:PSYCHIATRY DEPT
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3111
Practice Address - Country:US
Practice Address - Phone:216-363-2538
Practice Address - Fax:216-694-4604
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350754112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2205296Medicaid
OHHU7288001Medicare ID - Type Unspecified
OH2205296Medicaid