Provider Demographics
NPI:1942299367
Name:HUSAINY, NARGIS (MD)
Entity Type:Individual
Prefix:
First Name:NARGIS
Middle Name:
Last Name:HUSAINY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-2720
Mailing Address - Country:US
Mailing Address - Phone:620-624-5066
Mailing Address - Fax:620-624-2872
Practice Address - Street 1:23 E 11TH ST
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2720
Practice Address - Country:US
Practice Address - Phone:620-624-5066
Practice Address - Fax:620-624-2872
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045503208000000X
KYTP689208000000X
KS0433384208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000793614BMedicaid
GA000793614DMedicaid
GA37BBFDIMedicare ID - Type Unspecified
GA000793614BMedicaid
GA000793614DMedicaid