Provider Demographics
NPI:1154314722
Name:HUSSAIN, SHAHID (MD)
Entity Type:Individual
Prefix:
First Name:SHAHID
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 1:800 FREEPORT AVE NW STE 100
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-2723
Mailing Address - Country:US
Mailing Address - Phone:763-581-5200
Mailing Address - Fax:
Practice Address - Street 1:800 FREEPORT AVE NW STE 100
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-2723
Practice Address - Country:US
Practice Address - Phone:763-581-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN73510207R00000X
IN01041443A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL90001358OtherBCBSIL
IN200011080Medicaid
IL036067498Medicaid
C42854Medicare UPIN
IL90001358OtherBCBSIL