Provider Demographics
NPI:1407936974
Name:HUSSAIN, AHMED (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:
Last Name:HUSSAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1890 SILVER CROSS BLVD
Mailing Address - Street 2:STE 265
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-9623
Mailing Address - Country:US
Mailing Address - Phone:815-741-3532
Mailing Address - Fax:815-741-3736
Practice Address - Street 1:1890 SILVER CROSS BLVD
Practice Address - Street 2:STE 265
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9623
Practice Address - Country:US
Practice Address - Phone:815-741-3532
Practice Address - Fax:815-741-3736
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-079155207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036079155Medicaid
IL036079155Medicaid
ILL84346Medicare ID - Type Unspecified