Provider Demographics
NPI:1609028398
Name:HUSSAIN, MOHAMMAD MUSHAHID
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:MUSHAHID
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 1:837 AYERS ST
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-9047
Mailing Address - Country:US
Mailing Address - Phone:630-926-3055
Mailing Address - Fax:
Practice Address - Street 1:837 AYERS ST
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-9047
Practice Address - Country:US
Practice Address - Phone:630-926-3055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL500507765243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant