Provider Demographics
NPI:1356316517
Name:HUSSAIN, MUNAWAR (MD)
Entity Type:Individual
Prefix:DR
First Name:MUNAWAR
Middle Name:
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 1:4500 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:EAST MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61244-4248
Mailing Address - Country:US
Mailing Address - Phone:309-796-2777
Mailing Address - Fax:
Practice Address - Street 1:4500 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244-4248
Practice Address - Country:US
Practice Address - Phone:309-796-2777
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360061067207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL662680Medicare ID - Type Unspecified
ILD14522Medicare UPIN