Healthcare Provider Details

I. General information

NPI: 1912000696
Provider Name (Legal Business Name): KISHWAR HUSAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HEALTH PARK BLVD SUITE 4000
ST AUGUSTINE FL
32086-3707
US

IV. Provider business mailing address

300 HEALTH PARK BLVD STE 4000
ST AUGUSTINE FL
32086-3704
US

V. Phone/Fax

Practice location:
  • Phone: 904-824-8666
  • Fax: 904-824-8933
Mailing address:
  • Phone: 412-822-7410
  • Fax: 412-822-7411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME68363
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: