Provider Demographics
NPI:1770615981
Name:HUSSAIN, RAFIQ A (MD)
Entity type:Individual
Prefix:
First Name:RAFIQ
Middle Name:A
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:PO BOX 45318
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-0318
Mailing Address - Country:US
Mailing Address - Phone:440-243-7878
Mailing Address - Fax:440-243-1290
Practice Address - Street 1:18660 BAGLEY RD
Practice Address - Street 2:301 PHASE II
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3483
Practice Address - Country:US
Practice Address - Phone:440-243-7878
Practice Address - Fax:440-243-1290
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35034432207RN0300X, 246ZN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No246ZN0300XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0269525Medicaid
OH659294OtherBUREAU OF WORKMENS COMPEN
OH000000128294OtherANTHEM
OH341179615026OtherCARE SOURCE
OH341179615B01OtherMEDICAL MUTUAL
OH51781OtherDUAL CHOICE
OH341179615B01OtherMEDICAL MUTUAL
OH659294OtherBUREAU OF WORKMENS COMPEN