Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | 036-148265 | IL |
NPI | 1427242767 |
---|---|
Provider Name | Mohammad Hussain |
First Address | Springfield, IL 62702-5131 |
Second Address | Springfield, IL 62702-4901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2007 |
Last Update Date | 02/02/2021 |