Healthcare Provider Details

I. General information

NPI: 1003377912
Provider Name (Legal Business Name): SYED MUBASHIR HUSAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 N UNIVERSITY DR STE 204
TAMARAC FL
33321-1709
US

IV. Provider business mailing address

3080 GEIGER TER
OAKLAND PARK FL
33311-1188
US

V. Phone/Fax

Practice location:
  • Phone: 954-798-7114
  • Fax: 954-861-4565
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME162499
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberT8299
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME162499
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: