Provider Demographics
NPI:1851708085
Name:DR. ISHRAT HUSAIN LLC
Entity Type:Organization
Organization Name:DR. ISHRAT HUSAIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISHRAT
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-690-0888
Mailing Address - Street 1:1050 ISAAC STREETS DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3291
Mailing Address - Country:US
Mailing Address - Phone:419-690-0888
Mailing Address - Fax:419-690-8228
Practice Address - Street 1:1050 ISAAC STREETS DR
Practice Address - Street 2:SUITE 102
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3291
Practice Address - Country:US
Practice Address - Phone:419-690-0888
Practice Address - Fax:419-690-8228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH49280261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty