Provider Demographics
NPI:1568802825
Name:HUSAIN, MOHAMMAD MONWAR (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:MONWAR
Last Name:HUSAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MOHAMMAD
Other - Middle Name:MONWAR
Other - Last Name:HUSAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-2052
Mailing Address - Fax:239-343-5348
Practice Address - Street 1:9981 S HEALTHPARK DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908
Practice Address - Country:US
Practice Address - Phone:239-343-2052
Practice Address - Fax:239-343-5348
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME126685207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIU574WOtherMEDICARE
FLFAYSIOtherBCBS
FL019094600Medicaid
FLIU574WOtherMEDICARE