Provider Demographics
NPI:1275586067
Name:HUSSAIN, MOHAMMAD INAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:INAM
Last Name:HUSSAIN
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 1:1301 W 22ND ST
Mailing Address - Street 2:SUITE 610
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2006
Mailing Address - Country:US
Mailing Address - Phone:630-537-1720
Mailing Address - Fax:630-537-1724
Practice Address - Street 1:1301 W 22ND ST
Practice Address - Street 2:SUITE 610
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2006
Practice Address - Country:US
Practice Address - Phone:630-537-1720
Practice Address - Fax:630-537-1724
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01069989A207L00000X
IL036083169208VP0014X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036083169Medicaid
ILL99240Medicare ID - Type Unspecified
ILG15473Medicare UPIN