Provider Demographics
NPI:1386334175
Name:HUSSAIN, SHUJA
Entity type:Individual
Prefix:
First Name:SHUJA
Middle Name:
Last Name:HUSSAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W BIG BEAVER RD STE 300
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4725
Mailing Address - Country:US
Mailing Address - Phone:571-236-3262
Mailing Address - Fax:
Practice Address - Street 1:2222 W GRAND RIVER AVE STE A
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1604
Practice Address - Country:US
Practice Address - Phone:571-236-3262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide