Basic Information
| Provider Information | |||||||||
| NPI: | 1609842509 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUSSAIN | ||||||||
| FirstName: | KAZIM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HUSSAIN | ||||||||
| OtherFirstName: | KHADIM | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2686 W ALTON GLOOR BLVD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | BROWNSVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785204055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563505444 | ||||||||
| FaxNumber: | 9563502493 | ||||||||
| Practice Location | |||||||||
| Address1: | 2686 W ALTON GLOOR BLVD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | BROWNSVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785204054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563505444 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2006 | ||||||||
| LastUpdateDate: | 08/15/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | K8221 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207PE0004X | K8221 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | 138777121 | 05 | TX | MEDICAID |