Provider Demographics
NPI:1154406775
Name:HUSAIN, NADEEM M (MD)
Entity type:Individual
Prefix:
First Name:NADEEM
Middle Name:M
Last Name:HUSAIN
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 1:2227 W BASELINE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1250
Mailing Address - Country:US
Mailing Address - Phone:602-254-6640
Mailing Address - Fax:602-254-6164
Practice Address - Street 1:303 E BASELINE RD
Practice Address - Street 2:#105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6530
Practice Address - Country:US
Practice Address - Phone:602-254-6640
Practice Address - Fax:602-254-6164
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42751207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ484103Medicaid