MEDICARE: DR. TALIB 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	207RC0000X	Cardiovascular Disease Physician	ME21499	FL

General Provider Information

NPI Number	:	1417048836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TALIB HUSSAIN M.D.

Provider Business Mailing Address
First Line	:	7768 BAY ST
Second Line	:	SUITE 12
City	:	SEBASTIAN
State	:	FL
Zip	:	32958-3427
Country	:	US
Telephone Number	:	772-589-7177
Fax Number	:	772-589-9101

Provider Business Practice Location Address
First Line	:	7768 BAY ST
Second Line	:	SUITE 12
City	:	SEBASTIAN
State	:	FL
Zip	:	32958-3427
Country	:	US
Telephone Number	:	772-589-7177
Fax Number	:	772-589-9101

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/08/2007

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