Provider Demographics
NPI:1922197268
Name:HUSSAIN, SAKHAWAT (MD)
Entity Type:Individual
Prefix:
First Name:SAKHAWAT
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 1:16250 LOUIS AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-2260
Mailing Address - Country:US
Mailing Address - Phone:708-333-0001
Mailing Address - Fax:708-333-0042
Practice Address - Street 1:16250 LOUIS AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2260
Practice Address - Country:US
Practice Address - Phone:708-333-0001
Practice Address - Fax:708-333-0042
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21628534OtherBLUE CROSS BLUE SHIELD
100606OtherFEDERAL BLACK LUNG PROGRA
D13069Medicare UPIN
490231Medicare ID - Type Unspecified
IN183770Medicare ID - Type Unspecified