Healthcare Provider Details

I. General information

NPI: 1528258589
Provider Name (Legal Business Name): ANJUM S HUSSAINI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 N MAIN ST
SANDWICH IL
60548-2587
US

IV. Provider business mailing address

1302 N MAIN ST
SANDWICH IL
60548-2587
US

V. Phone/Fax

Practice location:
  • Phone: 815-786-8484
  • Fax: 815-981-7356
Mailing address:
  • Phone: 815-786-8484
  • Fax: 815-981-7356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036119527
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: