Healthcare Provider Details

I. General information

NPI: 1265408041
Provider Name (Legal Business Name): SYED FAWAD HUSSAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1641 E FLAMINGO RD #10
LAS VEGAS NV
89119-5257
US

IV. Provider business mailing address

1641 E FLAMINGO RD 10
LAS VEGAS NV
89119-5257
US

V. Phone/Fax

Practice location:
  • Phone: 702-734-4377
  • Fax: 702-369-8057
Mailing address:
  • Phone: 702-734-4377
  • Fax: 702-369-8057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number11399
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: