Provider Demographics
NPI:1700865722
Name:HOUSSEIN, ASSEM (MD)
Entity Type:Individual
Prefix:
First Name:ASSEM
Middle Name:
Last Name:HOUSSEIN
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 1:2405 N COLUMBUS ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8185
Mailing Address - Country:US
Mailing Address - Phone:740-689-6710
Mailing Address - Fax:740-689-6712
Practice Address - Street 1:2405 N COLUMBUS ST
Practice Address - Street 2:SUITE 130
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8185
Practice Address - Country:US
Practice Address - Phone:740-689-6710
Practice Address - Fax:740-689-6712
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.066193207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0999326Medicaid
OH0999326Medicaid
OHF92512Medicare UPIN