Provider Demographics
NPI:1336995588
Name:HUSSAIN, SYED IMAD
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:IMAD
Last Name:HUSSAIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 MOROSS ROAD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2172
Mailing Address - Country:US
Mailing Address - Phone:313-236-7909
Mailing Address - Fax:
Practice Address - Street 1:2201 MOROSS ROAD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2172
Practice Address - Country:US
Practice Address - Phone:313-343-7979
Practice Address - Fax:313-343-3939
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2025-05-08
Deactivation Date:2024-12-31
Deactivation Code:
Reactivation Date:2025-05-08
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program