Provider Demographics
NPI:1225116346
Name:SAKHAWAT HUSSAIN MDSC
Entity Type:Organization
Organization Name:SAKHAWAT HUSSAIN MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAKHAWAT
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-333-0001
Mailing Address - Street 1:16250 LOUIS AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-2260
Mailing Address - Country:US
Mailing Address - Phone:708-333-0001
Mailing Address - Fax:708-333-0042
Practice Address - Street 1:16250 LOUIS AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2260
Practice Address - Country:US
Practice Address - Phone:708-333-0001
Practice Address - Fax:708-333-0042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21628534OtherBLUE CROSS BLUE SHIELD
IL21628534OtherBLUE CROSS BLUE SHIELD
ILCN2691Medicare ID - Type UnspecifiedRR MEDICARE