Healthcare Provider Details

I. General information

NPI: 1396783452
Provider Name (Legal Business Name): SHAHID HUSSAIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SINAI GRACE HOSPITAL - ARDMORE CLINIC 14230 WEST MCNICHOLS
DETROIT MI
48235
US

IV. Provider business mailing address

1560 E MAPLE RD SUITE 400-CREDENTIALING
TROY MI
48083-1138
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-1199
  • Fax: 313-966-4916
Mailing address:
  • Phone: 248-581-5971
  • Fax: 248-581-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301063190
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: