Healthcare Provider Details

I. General information

NPI: 1194135400
Provider Name (Legal Business Name): SAMIRA HUSSAIN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1786 MOON LAKE BLVD STE 201
HOFFMAN ESTATES IL
60169-1067
US

IV. Provider business mailing address

1786 MOON LAKE BLVD STE 201
HOFFMAN ESTATES IL
60169-1067
US

V. Phone/Fax

Practice location:
  • Phone: 847-884-7550
  • Fax:
Mailing address:
  • Phone: 847-884-7550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036143890
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: