Provider Demographics
NPI:1740449495
Name:HUSSEIN, EHAB BAKIR (DO)
Entity type:Individual
Prefix:
First Name:EHAB
Middle Name:BAKIR
Last Name:HUSSEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4000 MIAMISBURG CENTERVILLE RD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-7615
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:2760 AIRPORT DR STE 120
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-2290
Practice Address - Country:US
Practice Address - Phone:614-586-0668
Practice Address - Fax:614-586-0669
Is Sole Proprietor?:No
Enumeration Date:2008-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202632207RP1001X
OH34-009596207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2298430Medicaid
OH2298430Medicaid
OH4281641Medicare PIN