Provider Demographics
NPI:1467128017
Name:HUSSAIN, SYED
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:
Last Name:HUSSAIN
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 1:24684 WARNER AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-1652
Mailing Address - Country:US
Mailing Address - Phone:586-248-2192
Mailing Address - Fax:
Practice Address - Street 1:3611 CARPENTER ST STE 5
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48212-2784
Practice Address - Country:US
Practice Address - Phone:313-733-8286
Practice Address - Fax:313-826-0899
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant