Provider Demographics
NPI:1487688925
Name:HUSSAIN, TAYEB S (DPM)
Entity Type:Individual
Prefix:MR
First Name:TAYEB
Middle Name:S
Last Name:HUSSAIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 RIDGE AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2455
Mailing Address - Country:US
Mailing Address - Phone:847-475-9030
Mailing Address - Fax:847-475-9031
Practice Address - Street 1:2500 RIDGE AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-2455
Practice Address - Country:US
Practice Address - Phone:847-475-9030
Practice Address - Fax:847-475-9031
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004816213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004816Medicaid
ILL76114Medicare ID - Type Unspecified
ILU62330Medicare UPIN