Healthcare Provider Details

I. General information

NPI: 1164620340
Provider Name (Legal Business Name): ABID HUSSAIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 S 6TH ST
MAYFIELD KY
42066-2311
US

IV. Provider business mailing address

417 S 6TH ST
MAYFIELD KY
42066-2311
US

V. Phone/Fax

Practice location:
  • Phone: 270-247-1104
  • Fax: 270-247-1107
Mailing address:
  • Phone: 270-247-1104
  • Fax: 270-247-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number41115
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: