Provider Demographics
NPI:1023074572
Name:HUSSAIN, SYED (MBBS)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:
Last Name:HUSSAIN
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 SERVICE ROAD
Mailing Address - Street 2:ROOM A217
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7040
Mailing Address - Country:US
Mailing Address - Phone:517-353-8122
Mailing Address - Fax:
Practice Address - Street 1:804 SERVICE ROAD
Practice Address - Street 2:ROOM A217
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-7040
Practice Address - Country:US
Practice Address - Phone:517-353-8122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI464852084N0400X
MI43010939692084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1023074572Medicaid
MIC36078027Medicare PIN