Healthcare Provider Details

I. General information

NPI: 1285044784
Provider Name (Legal Business Name): FAIZ AHMED HUSSAIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 W KILBOURN AVE STE 200
MILWAUKEE WI
53233-1325
US

IV. Provider business mailing address

411 E 17TH ST
LOMBARD IL
60148-4907
US

V. Phone/Fax

Practice location:
  • Phone: 414-219-7370
  • Fax: 41-421-9796
Mailing address:
  • Phone: 630-706-0558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.144035
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036.144035
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: