Provider Demographics
NPI:1164620340
Name:HUSSAIN, ABID (MD)
Entity Type:Individual
Prefix:DR
First Name:ABID
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 1:417 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-2311
Mailing Address - Country:US
Mailing Address - Phone:270-247-1104
Mailing Address - Fax:270-247-1107
Practice Address - Street 1:417 S 6TH ST
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-2311
Practice Address - Country:US
Practice Address - Phone:270-247-1104
Practice Address - Fax:270-247-1107
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41115208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY41115OtherLICENSE
KY41115OtherLICENSE