Provider Demographics
NPI:1982625794
Name:HUSSAIN, MOHAMMAD MAHMUD (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:MAHMUD
Last Name:HUSSAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9632 CONANT
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212
Mailing Address - Country:US
Mailing Address - Phone:313-871-1912
Mailing Address - Fax:313-871-1914
Practice Address - Street 1:9632 CONANT
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212
Practice Address - Country:US
Practice Address - Phone:313-871-1912
Practice Address - Fax:313-871-1914
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301069469208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104302449Medicaid
MI4302449Medicaid