Healthcare Provider Details

I. General information

NPI: 1124944897
Provider Name (Legal Business Name): HAWRA HUSSAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W. 13 MILE ROAD
ROYAL OAK MI
48073
US

IV. Provider business mailing address

3601 W. 13 MILE ROAD
ROYAL OAK MI
48073
US

V. Phone/Fax

Practice location:
  • Phone: 248-551-3000
  • Fax: 248-551-9425
Mailing address:
  • Phone: 248-551-3000
  • Fax: 248-551-9425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4351056524
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: