Healthcare Provider Details

I. General information

NPI: 1770557225
Provider Name (Legal Business Name): MOHAMMED I HUSSAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 HART BLVD
MONTICELLO MN
55362-8575
US

IV. Provider business mailing address

9136 W RIVER RD
BROOKLYN PARK MN
55444-1218
US

V. Phone/Fax

Practice location:
  • Phone: 763-271-2248
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number42661
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: