Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 036.117664 | IL |
NPI | 1003025438 |
---|---|
Provider Name | Dr. Ayesha Hussain |
First Address | Chicago, IL 60659-4100 |
Second Address | Chicago, IL 60659-4100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 31/01/2022 |