Provider Demographics
NPI:1609842509
Name:HUSSAIN, KAZIM (MD)
Entity Type:Individual
Prefix:
First Name:KAZIM
Middle Name:
Last Name:HUSSAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KHADIM
Other - Middle Name:
Other - Last Name:HUSSAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2686 W ALTON GLOOR BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-4055
Mailing Address - Country:US
Mailing Address - Phone:956-350-5444
Mailing Address - Fax:956-350-2493
Practice Address - Street 1:2686 W ALTON GLOOR BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-4054
Practice Address - Country:US
Practice Address - Phone:956-350-5444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8221207R00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138777121Medicaid
TX138777121Medicaid