Provider Demographics
NPI:1669769295
Name:HUSAIN, INNA (MD)
Entity type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:HUSAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8558 BROADWAY # 1325
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7032
Mailing Address - Country:US
Mailing Address - Phone:193-927-0842
Mailing Address - Fax:219-703-6854
Practice Address - Street 1:9200 CALUMET AVE STE N502
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2862
Practice Address - Country:US
Practice Address - Phone:219-703-2449
Practice Address - Fax:219-703-6795
Is Sole Proprietor?:No
Enumeration Date:2011-07-04
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125060476207Y00000X
IN01088980A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300069430Medicaid