Healthcare Provider Details

I. General information

NPI: 1639320617
Provider Name (Legal Business Name): NICHOLAS HUSNI, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 10/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 ROCKSIDE RD. 640
INDEPENDENCE OH
44131
US

IV. Provider business mailing address

5005 ROCKSIDE RD. 640
INDEPENDENCE OH
44131
US

V. Phone/Fax

Practice location:
  • Phone: 216-328-0800
  • Fax: 216-328-1860
Mailing address:
  • Phone: 216-328-0800
  • Fax: 216-328-1860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number35-08-5059
License Number StateOH

VIII. Authorized Official

Name: NICHOLAS R. HUSNI
Title or Position: PRESIDENT
Credential: M.D., PH.D.
Phone: 216-328-0800