Provider Demographics
NPI:1922047729
Name:HUSSAIN, IRSHAD (MD)
Entity Type:Individual
Prefix:DR
First Name:IRSHAD
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 1:15921 BOUNDARY DR
Mailing Address - Street 2:P O BOX 92
Mailing Address - City:ASHLAND
Mailing Address - State:MS
Mailing Address - Zip Code:38603-7740
Mailing Address - Country:US
Mailing Address - Phone:662-224-8951
Mailing Address - Fax:662-224-6459
Practice Address - Street 1:15921 BOUNDARY DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MS
Practice Address - Zip Code:38603-7740
Practice Address - Country:US
Practice Address - Phone:662-224-8951
Practice Address - Fax:662-224-6459
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2017-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15021207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0117430Medicaid
MS0117430Medicaid