Provider Demographics
NPI:1750324844
Name:HUSAIN, SHASHI A (MD)
Entity Type:Individual
Prefix:
First Name:SHASHI
Middle Name:A
Last Name:HUSAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 21228
Mailing Address - Street 2:DEPT 144
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74121-1228
Mailing Address - Country:US
Mailing Address - Phone:918-587-5534
Mailing Address - Fax:918-587-5610
Practice Address - Street 1:1145 S UTICA AVE
Practice Address - Street 2:SUITE 520
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4000
Practice Address - Country:US
Practice Address - Phone:918-587-5534
Practice Address - Fax:918-587-5610
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK13418174400000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100248550BMedicaid
OK731192479002OtherTRICARE
OK731192479001OtherBLUE CROSS BLUE SHIELD
OK731192479OtherCOMMERICAL
OKP00637428OtherRAILROAD MCARE THRU NSO
OK731192479001OtherBLUE CROSS BLUE SHIELD
OK731192479002OtherTRICARE