Healthcare Provider Details

I. General information

NPI: 1093704868
Provider Name (Legal Business Name): AKHTAR HUSAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 08/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14720 KING RD SUITE B
RIVERVIEW MI
48193-7945
US

IV. Provider business mailing address

14720 KING RD SUITE B
RIVERVIEW MI
48193-7945
US

V. Phone/Fax

Practice location:
  • Phone: 734-675-1150
  • Fax: 734-675-1173
Mailing address:
  • Phone: 734-675-1150
  • Fax: 734-675-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301088891
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: