Provider Demographics
NPI:1366564973
Name:SARWAR HUSAIN M.D., INC
Entity type:Organization
Organization Name:SARWAR HUSAIN M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:DREYER-TUTAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-763-3808
Mailing Address - Street 1:7447 W TALCOTT AVE
Mailing Address - Street 2:SUITE 415
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3745
Mailing Address - Country:US
Mailing Address - Phone:773-763-3808
Mailing Address - Fax:773-774-3739
Practice Address - Street 1:7447 W TALCOTT AVE
Practice Address - Street 2:SUITE 415
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3745
Practice Address - Country:US
Practice Address - Phone:773-763-3808
Practice Address - Fax:773-774-3739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036081914Medicaid
IL036081914Medicaid