Provider Demographics
NPI:1598933558
Name:HUSSAIN, NOMAN A (MD)
Entity Type:Individual
Prefix:MR
First Name:NOMAN
Middle Name:A
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 1:7777 FOREST LANE
Mailing Address - Street 2:SUITE B412
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-9998
Mailing Address - Country:US
Mailing Address - Phone:972-566-5560
Mailing Address - Fax:972-566-5562
Practice Address - Street 1:7777 FOREST LANE
Practice Address - Street 2:SUITE B412
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-9998
Practice Address - Country:US
Practice Address - Phone:972-566-5560
Practice Address - Fax:972-566-5562
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085421208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX419675001Medicaid
MI70-0-F32947-0OtherBCBS CPIN #
MI1598933558Medicaid