Healthcare Provider Details

I. General information

NPI: 1730155581
Provider Name (Legal Business Name): SUNNY ZAHEED HUSSAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2508 BERT KOUN LOOP SUITE 101
SHREVEPORT LA
71118-3133
US

IV. Provider business mailing address

1202 LOUISIANA AVE
SHREVEPORT LA
71101-3910
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-5858
  • Fax: 318-212-5877
Mailing address:
  • Phone: 318-212-5858
  • Fax: 318-212-5877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number200680
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: