Healthcare Provider Details

I. General information

NPI: 1073582201
Provider Name (Legal Business Name): IRSHAD HUSSAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 S MAIN ST
DAYTON OH
45409-2687
US

IV. Provider business mailing address

4000 MIAMISBURG CENTERVILLE RD STE 100
MIAMISBURG OH
45342-7615
US

V. Phone/Fax

Practice location:
  • Phone: 937-223-3053
  • Fax: 937-853-0166
Mailing address:
  • Phone: 937-298-8058
  • Fax: 937-866-6713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35.078335
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: