MEDICARE: DR. MUNAWAR HUSSAIN M.D.

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	207V00000X	Obstetrics & Gynecology Physician	0360061067	IL

General Provider Information

NPI Number	:	1356316517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MUNAWAR HUSSAIN M.D.

Provider Business Mailing Address
First Line	:	4500 KENNEDY DR
Second Line	:
City	:	EAST MOLINE
State	:	IL
Zip	:	61244-4248
Country	:	US
Telephone Number	:	309-796-2777
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 KENNEDY DR
Second Line	:
City	:	EAST MOLINE
State	:	IL
Zip	:	61244-4248
Country	:	US
Telephone Number	:	309-796-2777
Fax Number	:

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	07/08/2007

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