Healthcare Provider Details

I. General information

NPI: 1225477409
Provider Name (Legal Business Name): HUMA M HOSAIN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 W 16TH ST #2364
INDIANAPOLIS IN
46202-2207
US

IV. Provider business mailing address

355 W 16TH ST #2364
INDIANAPOLIS IN
46202-2207
US

V. Phone/Fax

Practice location:
  • Phone: 317-963-7307
  • Fax:
Mailing address:
  • Phone: 317-963-7307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number11019174A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: