Provider Demographics
NPI:1205813714
Name:HUSSAIN, SYED K (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:K
Last Name:HUSSAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1444 THOMAS MASON PL
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4423
Mailing Address - Country:US
Mailing Address - Phone:314-283-3202
Mailing Address - Fax:314-293-6769
Practice Address - Street 1:915 N GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-1621
Practice Address - Country:US
Practice Address - Phone:314-652-4100
Practice Address - Fax:314-289-7937
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2024-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036092117207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036092117Medicaid
K04224Medicare PIN
IL036092117Medicaid
208376Medicare PIN
G47287Medicare UPIN