Provider Demographics
NPI:1790737799
Name:HURAIBI, HUSSEIN A (MD)
Entity Type:Individual
Prefix:DR
First Name:HUSSEIN
Middle Name:A
Last Name:HURAIBI
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 1:13530 MICHIGAN AVE STE 190
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3574
Mailing Address - Country:US
Mailing Address - Phone:313-486-1030
Mailing Address - Fax:313-761-1646
Practice Address - Street 1:3600 NW SAMARITAN DR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-5472
Practice Address - Country:US
Practice Address - Phone:541-768-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066286207L00000X, 208VP0014X
ORMD214569207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315057615OtherCDS #
MI4301066286OtherSTATE LICENSE #
MI0P12330001OtherMEDICARE IND PIN #
MI470874910Medicaid
MI11279065OtherCAQH
MI1790737799OtherBCBS TYPE 1 (IND) NPI #
MI11279065OtherCAQH