Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 01030793 | IN |
N | 2080P0207X | Pediatric Hematology-Oncologist | 01030793 | IN |
NPI | 1003883265 |
---|---|
Provider Name | Dr. Mohammad I Hussain |
First Address | Evansville, IN 47714 |
Second Address | Evansville, IN 47714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 14/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100246530 | (05) | IN |