MEDICARE: SYED FAWAD HUSSAIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	11399	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DH475Y	OTHER		MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	CC4470	OTHER	NV	BLUE CROSS

General Provider Information

NPI Number	:	1265408041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYED FAWAD HUSSAIN MD

Provider Business Mailing Address
First Line	:	1641 E FLAMINGO RD
Second Line	:	10
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5257
Country	:	US
Telephone Number	:	702-734-4377
Fax Number	:	702-369-8057

Provider Business Practice Location Address
First Line	:	1641 E FLAMINGO RD
Second Line	:	#10
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5257
Country	:	US
Telephone Number	:	702-734-4377
Fax Number	:	702-369-8057

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	11/08/2011

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