Provider Demographics
NPI:1760492466
Name:HUSSAIN, IKRAM (MD)
Entity Type:Individual
Prefix:
First Name:IKRAM
Middle Name:
Last Name:HUSSAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:AL
Mailing Address - Zip Code:36545-2459
Mailing Address - Country:US
Mailing Address - Phone:251-246-9021
Mailing Address - Fax:251-246-1122
Practice Address - Street 1:220 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:AL
Practice Address - Zip Code:36545-2459
Practice Address - Country:US
Practice Address - Phone:251-246-9021
Practice Address - Fax:251-246-1122
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00025412207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-21454OtherBLUE CROSS BLUE SHIELD
AL009949265Medicaid
AL515-21454OtherBLUE CROSS BLUE SHIELD
AL051521454HUSMedicare ID - Type Unspecified