Basic Information
| Provider Information | |||||||||
| NPI: | 1215347125 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUSSAINI | ||||||||
| FirstName: | KAMRAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1402 S. GRAND | ||||||||
| Address2: | FDT 12TH FLOOR | ||||||||
| City: | ST. LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149776100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 HEALTH CARE DR | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622461154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186641230 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2014 | ||||||||
| LastUpdateDate: | 10/08/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 2018003023 | MO | N | Allopathic & Osteopathic Physicians | Hospitalist | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208M00000X | 036.142642 | IL | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 036.142642 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.