Provider Demographics
NPI:1245417070
Name:ABDUL HUSSAIN, MAYSA H (MD)
Entity Type:Individual
Prefix:
First Name:MAYSA
Middle Name:H
Last Name:ABDUL HUSSAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36123 SCHOOLCRAFT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-1216
Mailing Address - Country:US
Mailing Address - Phone:734-793-6140
Mailing Address - Fax:865-560-8948
Practice Address - Street 1:600 N FAIRBANKS CT UNIT 3202
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5866
Practice Address - Country:US
Practice Address - Phone:414-334-1972
Practice Address - Fax:414-334-1972
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI513-990-20207R00000X
IN01069723A207R00000X
IL336097633207R00000X
WI51399208M00000X
NMMD2019-1032207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100004812Medicaid
IN201045320Medicaid
INM400065107Medicare PIN