Healthcare Provider Details

I. General information

NPI: 1669769295
Provider Name (Legal Business Name): INNA HUSAIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2011
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 CALUMET AVE STE N502
MUNSTER IN
46321-2862
US

IV. Provider business mailing address

8558 BROADWAY # 1325
MERRILLVILLE IN
46410-7032
US

V. Phone/Fax

Practice location:
  • Phone: 219-703-2449
  • Fax: 219-703-6795
Mailing address:
  • Phone: 193-927-0842
  • Fax: 219-703-6854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number125060476
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number01088980A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: