Provider Demographics
NPI:1487731816
Name:HUSAIN, MAIMOONA HAKIM (MD)
Entity type:Individual
Prefix:
First Name:MAIMOONA
Middle Name:HAKIM
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 1:19445 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-3361
Mailing Address - Country:US
Mailing Address - Phone:313-307-0088
Mailing Address - Fax:313-281-2235
Practice Address - Street 1:19445 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-3361
Practice Address - Country:US
Practice Address - Phone:313-307-0088
Practice Address - Fax:313-281-2235
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301050453208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF22273Medicare UPIN
MI0P22910Medicare ID - Type Unspecified