Provider Demographics
NPI:1235581877
Name:HUSEYNOV, AYDIN
Entity Type:Individual
Prefix:
First Name:AYDIN
Middle Name:
Last Name:HUSEYNOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 CALLAN AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2973
Mailing Address - Country:US
Mailing Address - Phone:773-865-8018
Mailing Address - Fax:515-967-5177
Practice Address - Street 1:434 CALLAN AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2973
Practice Address - Country:US
Practice Address - Phone:773-865-8018
Practice Address - Fax:515-967-5177
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver