Provider Demographics
NPI:1952162513
Name:HUSSEIN, ABDIMAJID AHMED
Entity Type:Individual
Prefix:
First Name:ABDIMAJID
Middle Name:AHMED
Last Name:HUSSEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12607 TAYLORSVILLE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2462
Mailing Address - Country:US
Mailing Address - Phone:502-701-8500
Mailing Address - Fax:
Practice Address - Street 1:12607 TAYLORSVILLE RD STE 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-2462
Practice Address - Country:US
Practice Address - Phone:502-701-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYH17985127172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver