Healthcare Provider Details

I. General information

NPI: 1124071048
Provider Name (Legal Business Name): RIFAT HUSSAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W 22ND ST STE 104
SIOUX FALLS SD
57105
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 605-328-0000
  • Fax: 605-328-0012
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number2118
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: