Provider Demographics
NPI:1497115059
Name:HUSAIN, ISMAIL UMAR (DO)
Entity Type:Individual
Prefix:
First Name:ISMAIL
Middle Name:UMAR
Last Name:HUSAIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 NILES CORTLAND RD NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-1976
Mailing Address - Country:US
Mailing Address - Phone:330-372-0260
Mailing Address - Fax:330-372-0261
Practice Address - Street 1:349 NILES CORTLAND RD NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-1976
Practice Address - Country:US
Practice Address - Phone:330-372-0260
Practice Address - Fax:330-372-0261
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSS929978207R00000X
OH34014644207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0336526Medicaid