Provider Demographics
NPI:1164641874
Name:HUSNAIN, SYED SHAUKAT (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:SHAUKAT
Last Name:HUSNAIN
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 1:850 W 3RD NORTH ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-3824
Mailing Address - Country:US
Mailing Address - Phone:423-581-2795
Mailing Address - Fax:423-581-7113
Practice Address - Street 1:850 W 3RD NORTH ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3824
Practice Address - Country:US
Practice Address - Phone:423-581-2795
Practice Address - Fax:423-581-7113
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN032093207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4110711OtherBLUE CROSS BLUE SHIELD
TN100037145OtherPHP TRICARE PROVIDER
TNTN0101OtherAMERICHOICE UNITED HEALTH
TN3334045Medicaid
TNTN0101OtherAMERICHOICE UNITED HEALTH
TN4110711OtherBLUE CROSS BLUE SHIELD