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General NPI Number Information
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NPI Number | 1669365201
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Entity Type | Individual
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Provider Name | MARIAM HUSSAIN
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Gender | Female
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 2650 WARRENVILLE RD STE 280
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-2075
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Country | US
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Telephone | 630-324-7920
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Fax | 630-271-1813
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Provider Business Mailing Address
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Address Line | 12205 RED CLOVER LN
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City | PLAINFIELD
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State | IL
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Zip | 60585-7847
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Country | US
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Telephone | 630-853-0400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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