Healthcare Provider Details

I. General information

NPI: 1770716680
Provider Name (Legal Business Name): TAARIF HUSSAIN M.D. FAAFP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 11/14/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 E MAUMEE ST
ANGOLA IN
46703-2015
US

IV. Provider business mailing address

608 UNION CHAPEL RD
FORT WAYNE IN
46845-9357
US

V. Phone/Fax

Practice location:
  • Phone: 260-498-2020
  • Fax:
Mailing address:
  • Phone: 605-179-2902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number60272125
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01081471A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: