Healthcare Provider Details

I. General information

NPI: 1295056216
Provider Name (Legal Business Name): SYED A HUSSAINI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 06/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 WEST MAIN STREET
GENEVA OH
44041
US

IV. Provider business mailing address

810 WEST MAIN STREET
GENEVA OH
44041
US

V. Phone/Fax

Practice location:
  • Phone: 440-466-5889
  • Fax: 440-466-5889
Mailing address:
  • Phone: 440-466-5889
  • Fax: 440-466-5889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-041030
License Number StateOH

VIII. Authorized Official

Name: DR. SYED A HUSSAINI
Title or Position: OWNER
Credential: MD
Phone: 440-466-5889