Provider Demographics
NPI:1316924640
Name:HUSAIN, JUGNOO (MD)
Entity type:Individual
Prefix:DR
First Name:JUGNOO
Middle Name:
Last Name:HUSAIN
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 1:14275 MIDWAY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:317-275-8000
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:2560 N. SHADELAND AVE.
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-1706
Practice Address - Country:US
Practice Address - Phone:317-275-8000
Practice Address - Fax:317-275-8018
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039972A207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000372826OtherANTHEM
IN200099170AMedicaid
G31573Medicare UPIN
679170UUMedicare ID - Type Unspecified
P00260531Medicare ID - Type UnspecifiedRAILROAD MEDICARE