Provider Demographics
NPI:1174838825
Name:HUSAIN, SYED ALI MUTTAQI (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED ALI MUTTAQI
Middle Name:
Last Name:HUSAIN
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 1:43303 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-1959
Mailing Address - Country:US
Mailing Address - Phone:586-739-8674
Mailing Address - Fax:586-739-5576
Practice Address - Street 1:43303 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1959
Practice Address - Country:US
Practice Address - Phone:586-739-8674
Practice Address - Fax:586-739-5576
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301096702207R00000X, 207RR0500X
OK32114208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1174838825Medicaid