Provider Demographics
NPI:1467770925
Name:HUSSAIN, HAFIZ GHULAM (MD)
Entity type:Individual
Prefix:
First Name:HAFIZ
Middle Name:GHULAM
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 1:305 N. MANGOUSTINE AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771
Mailing Address - Country:US
Mailing Address - Phone:321-363-9335
Mailing Address - Fax:321-219-9930
Practice Address - Street 1:305 N. MANGOUSTINE AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771
Practice Address - Country:US
Practice Address - Phone:321-363-9335
Practice Address - Fax:321-219-9930
Is Sole Proprietor?:No
Enumeration Date:2010-05-08
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME152688207RI0011X
NY277912207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease