Basic Information
| Provider Information | |||||||||
| NPI: | 1275586067 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUSSAIN | ||||||||
| FirstName: | MOHAMMAD | ||||||||
| MiddleName: | INAM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 W 22ND ST | ||||||||
| Address2: | SUITE 610 | ||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605232006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305371720 | ||||||||
| FaxNumber: | 6305371724 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 W 22ND ST | ||||||||
| Address2: | SUITE 610 | ||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605232006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305371720 | ||||||||
| FaxNumber: | 6305371724 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 10/16/2017 | ||||||||
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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 | 207L00000X | 01069989A | IN | N | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0014X | 036083169 | IL | N | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 207L00000X | 036083169 | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 036083169 | 05 | IL | MEDICAID |