Healthcare Provider Details

I. General information

NPI: 1023336997
Provider Name (Legal Business Name): HUSSAIN MOHAMMED KHRAD MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 BRUCE B DOWNS BLVD ADDICTION PSYCHIATRY
TAMPA FL
33612-4745
US

IV. Provider business mailing address

13000 BRUCE B DOWNS BLVD ADDICTION PSYCHIATRY
TAMPA FL
33612-4745
US

V. Phone/Fax

Practice location:
  • Phone: 617-302-6116
  • Fax:
Mailing address:
  • Phone: 617-302-6116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number244609
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberME120097
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: