Healthcare Provider Details

I. General information

NPI: 1942560974
Provider Name (Legal Business Name): FAIZUL HUSSAIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 E ALTAMONTE DR STE 213
ALTAMONTE SPRINGS FL
32701-5102
US

IV. Provider business mailing address

407 SE 9TH ST STE 103
FORT LAUDERDALE FL
33316-1113
US

V. Phone/Fax

Practice location:
  • Phone: 407-951-5883
  • Fax: 407-951-8326
Mailing address:
  • Phone: 954-463-0112
  • Fax: 954-463-0117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberOS14676
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: