Healthcare Provider Details

I. General information

NPI: 1780654467
Provider Name (Legal Business Name): KARIM HUSSEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 RIVERBEND DR
SPRINGFIELD OR
97477-8800
US

IV. Provider business mailing address

715 E WESTERN RESERVE RD
POLAND OH
44514-3358
US

V. Phone/Fax

Practice location:
  • Phone: 541-484-4332
  • Fax: 541-302-0786
Mailing address:
  • Phone: 330-726-3204
  • Fax: 330-729-9316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35086396
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD185343
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: