Provider Demographics
NPI:1780784934
Name:HUSSAIN, MIRZA JAVED (MD)
Entity type:Individual
Prefix:DR
First Name:MIRZA
Middle Name:JAVED
Last Name:HUSSAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MIRZA
Other - Middle Name:JAVED
Other - Last Name:HUSSAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:70 N FROST DR STE 4
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-5796
Mailing Address - Country:US
Mailing Address - Phone:989-790-2690
Mailing Address - Fax:989-790-4759
Practice Address - Street 1:70 N FROST DR STE 4
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-5796
Practice Address - Country:US
Practice Address - Phone:989-790-2690
Practice Address - Fax:989-790-4759
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068966207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4792377Medicaid
P00259294OtherPALMETTO GBS
1107311762OtherBCBS MICHIGAN
1107311762OtherBCBS MICHIGAN
G37370Medicare UPIN