Provider Demographics
NPI:1356722961
Name:HUSSAIN, SADIA (DO)
Entity type:Individual
Prefix:
First Name:SADIA
Middle Name:
Last Name:HUSSAIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9977 WOODS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1057
Mailing Address - Country:US
Mailing Address - Phone:847-663-8163
Mailing Address - Fax:847-663-1024
Practice Address - Street 1:8600 75TH ST STE 101
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-8200
Practice Address - Country:US
Practice Address - Phone:262-652-9430
Practice Address - Fax:262-652-9433
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036145178208000000X
WI8142021208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1356722961Medicaid