Healthcare Provider Details

I. General information

NPI: 1093334047
Provider Name (Legal Business Name): MURTAZA SHABBIR HUSSAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 BARRY DR
LAPEER MI
48446-3661
US

IV. Provider business mailing address

1200 BARRY DR
LAPEER MI
48446-3661
US

V. Phone/Fax

Practice location:
  • Phone: 810-667-7304
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number4301517774
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: