Provider Demographics
NPI:1265408041
Name:HUSSAIN, SYED FAWAD (MD)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:FAWAD
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 1:1641 E FLAMINGO RD
Mailing Address - Street 2:10
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5257
Mailing Address - Country:US
Mailing Address - Phone:702-734-4377
Mailing Address - Fax:702-369-8057
Practice Address - Street 1:1641 E FLAMINGO RD
Practice Address - Street 2:#10
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5257
Practice Address - Country:US
Practice Address - Phone:702-734-4377
Practice Address - Fax:702-369-8057
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV11399207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506595Medicaid
NVCC4470OtherBLUE CROSS
DH475YOtherMEDICARE PTAN
NV100506595Medicaid
DH475YOtherMEDICARE PTAN