MEDICARE: MRS. ANJUM P. 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	208000000X	Pediatrics Physician	ME60312	FL

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	12939	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427163054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANJUM P. HUSSAIN M.D.

Provider Business Mailing Address
First Line	:	255 NE 19TH DR
Second Line	:
City	:	OKEECHOBEE
State	:	FL
Zip	:	34972-1933
Country	:	US
Telephone Number	:	863-467-8398
Fax Number	:	863-467-9850

Provider Business Practice Location Address
First Line	:	255 NE 19TH DR
Second Line	:
City	:	OKEECHOBEE
State	:	FL
Zip	:	34972-1933
Country	:	US
Telephone Number	:	863-467-8398
Fax Number	:	863-467-9850

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	09/15/2016

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