Healthcare Provider Details

I. General information

NPI: 1841494416
Provider Name (Legal Business Name): AMINA HUSAIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMINA ZAMAN MD

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20303 CRAWFORD AVE
OLYMPIA FIELDS IL
60461-1073
US

IV. Provider business mailing address

8370 PARAGON RD
DAYTON OH
45458-2135
US

V. Phone/Fax

Practice location:
  • Phone: 708-898-1858
  • Fax:
Mailing address:
  • Phone: 937-223-9117
  • Fax: 937-496-3595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35097337
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2008-00496
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036.148389
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: