1275610719 NPI number — IMTIAZ HUSSAIN MD

Table of content: IMTIAZ HUSSAIN MD (NPI 1275610719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275610719 NPI number — IMTIAZ HUSSAIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUSSAIN
Provider First Name:
IMTIAZ
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275610719
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 KEENE MANOR CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NICHOLASVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40356-7910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-533-1467
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
306 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH WILLIAMSON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41503-4095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-237-4943
Provider Business Practice Location Address Fax Number:
606-237-1740
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  29223 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 29223 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1473277 . This is a "UMWA HEALTH & RETIREMENT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000202232 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010721900 . This is a "FEDERAL BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 611265801 . This is a "BRICK STREET ADMINISTRATI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64292238 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0075636000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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