Provider Demographics
NPI:1013924497
Name:HUSAIN, ASIF (MD)
Entity Type:Individual
Prefix:DR
First Name:ASIF
Middle Name:
Last Name:HUSAIN
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 1:2275 WESTPARK CT
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-3999
Mailing Address - Country:US
Mailing Address - Phone:817-354-0052
Mailing Address - Fax:817-354-9222
Practice Address - Street 1:2275 WESTPARK CT
Practice Address - Street 2:SUITE # 101
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3999
Practice Address - Country:US
Practice Address - Phone:817-354-0052
Practice Address - Fax:817-354-9222
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4311208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032217401Medicaid
TXOOBD813OtherBLUE CROSS & BLUE SHIELD
BD81Medicare ID - Type Unspecified
TX032217401Medicaid