Provider Demographics
NPI:1063477214
Name:HUSSEIN, SAMER H (MD)
Entity type:Individual
Prefix:
First Name:SAMER
Middle Name:H
Last Name:HUSSEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 11TH ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:KY
Mailing Address - Zip Code:41008-1435
Mailing Address - Country:US
Mailing Address - Phone:502-732-9922
Mailing Address - Fax:502-732-9050
Practice Address - Street 1:309 11TH ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:KY
Practice Address - Zip Code:41008-1435
Practice Address - Country:US
Practice Address - Phone:502-732-9922
Practice Address - Fax:502-732-9050
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33015207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY110161889OtherRRMCR
KY000000381960OtherANTHEM-NICC
KYG56887Medicare UPIN
KY1361986Medicare PIN