Healthcare Provider Details

I. General information

NPI: 1245487438
Provider Name (Legal Business Name): ELORA HUSSAIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MICHIGAN ST. NE
GRAND RAPIDS MI
49503
US

IV. Provider business mailing address

100 MICHIGAN ST. NE MC 845
GRAND RAPIDS MI
49503-4950
US

V. Phone/Fax

Practice location:
  • Phone: 616-267-0118
  • Fax: 616-267-0090
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number4301111422
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number4301111422
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301111422
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: