Provider Demographics
NPI:1952950511
Name:HUSSEIN, IMAN M
Entity Type:Individual
Prefix:
First Name:IMAN
Middle Name:M
Last Name:HUSSEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 THOMAS ST APT 205
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38107-1464
Mailing Address - Country:US
Mailing Address - Phone:812-406-3141
Mailing Address - Fax:
Practice Address - Street 1:605 THOMAS ST APT 205
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38107-1464
Practice Address - Country:US
Practice Address - Phone:812-406-3141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)