Provider Demographics
NPI:1134780547
Name:HUSAIN, BATOOL HUZAIFA (MBBS)
Entity type:Individual
Prefix:
First Name:BATOOL HUZAIFA
Middle Name:
Last Name:HUSAIN
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:BATOOL
Other - Middle Name:
Other - Last Name:QUTBUDDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS
Mailing Address - Street 1:220 N ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-6159
Mailing Address - Country:US
Mailing Address - Phone:409-354-4622
Mailing Address - Fax:
Practice Address - Street 1:1740 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:866-600-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036163264207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology