Healthcare Provider Details

I. General information

NPI: 1710568357
Provider Name (Legal Business Name): HIRA HUSSAIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 S RIVERSIDE PLZ
CHICAGO IL
60606-3728
US

IV. Provider business mailing address

12101 NW 18TH ST
PLANTATION FL
33323-2123
US

V. Phone/Fax

Practice location:
  • Phone: 312-273-4930
  • Fax:
Mailing address:
  • Phone: 954-609-5770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036169169
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: