MEDICARE: MAIMOONA HAKIM HUSAIN 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	208D00000X	General Practice Physician	4301050453	MI

General Provider Information

NPI Number	:	1487731816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAIMOONA HAKIM HUSAIN M.D.

Provider Business Mailing Address
First Line	:	19445 W WARREN AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48228-3361
Country	:	US
Telephone Number	:	313-307-0088
Fax Number	:	313-281-2235

Provider Business Practice Location Address
First Line	:	19445 W WARREN AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48228-3361
Country	:	US
Telephone Number	:	313-307-0088
Fax Number	:	313-281-2235

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	12/02/2021

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