Provider Demographics
NPI:1780681718
Name:FATIMA, ASFIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ASFIA
Middle Name:
Last Name:FATIMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ASFIA
Other - Middle Name:FATIMA
Other - Last Name:HUSSAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 S 31ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76508-0001
Practice Address - Country:US
Practice Address - Phone:254-771-8424
Practice Address - Fax:254-724-3960
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8106207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL203536OtherGROUP MEDFICARE # LAKE COUNTY
IL036108330Medicaid
IL203535OtherGROUP MEDICARE # COOK
IL203537OtherGROUP MEDICARE # MCHENRY CO
IL203536OtherGROUP MEDFICARE # LAKE COUNTY