=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629119607
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | UZMA AZIZ HUSSAIN DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5533 W CERMAK RD
-----------------------------------------------------
City | CICERO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60804-2218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-863-6366
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15732 SHIRE DR
-----------------------------------------------------
City | ORLAND PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60467-9418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-545-7635
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------