Provider Demographics
NPI:1063935617
Name:HUSSAIN, FATIMA SALIM (MD)
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:SALIM
Last Name:HUSSAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 NW 12TH AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1005
Mailing Address - Country:US
Mailing Address - Phone:305-243-3166
Mailing Address - Fax:305-243-2617
Practice Address - Street 1:1601 NW 12TH AVE FL 1
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-243-3166
Practice Address - Fax:305-243-2617
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1444862080P0206X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology