Provider Demographics
NPI:1639179054
Name:HUSSAIN, MOHAMMED BELAYET (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:BELAYET
Last Name:HUSSAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:M
Other - Middle Name:BELAYET
Other - Last Name:HUSSAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3130 N DIXIE HWY
Mailing Address - Street 2:STE. 205
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1337
Mailing Address - Country:US
Mailing Address - Phone:937-335-0061
Mailing Address - Fax:937-339-9336
Practice Address - Street 1:3130 N DIXIE HWY
Practice Address - Street 2:STE. 205
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1337
Practice Address - Country:US
Practice Address - Phone:937-335-0061
Practice Address - Fax:937-339-9336
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058894208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0779582Medicaid
B60093Medicare UPIN