Provider Demographics
NPI:1821182361
Name:HUSAIN, S KHALID (DPM)
Entity Type:Individual
Prefix:
First Name:S
Middle Name:KHALID
Last Name:HUSAIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 WEST CENTRAL RD - SUITE 3500
Mailing Address - Street 2:MIDWEST FOOT & ANKLE CLINICS
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005
Mailing Address - Country:US
Mailing Address - Phone:847-398-8637
Mailing Address - Fax:847-398-4349
Practice Address - Street 1:880 WEST CENTRAL RD - SUITE 3500
Practice Address - Street 2:MIDWEST FOOT & ANKLE CLINICS
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005
Practice Address - Country:US
Practice Address - Phone:847-398-8637
Practice Address - Fax:847-398-4349
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004842213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004842OtherIL STATE LICENSE #
IL016004842Medicaid
ILU71682Medicare UPIN
IL2510530001Medicare NSC
IL016004842OtherIL STATE LICENSE #