Provider Demographics
NPI:1528175932
Name:HUSSAIN, BASHARAT (MD)
Entity type:Individual
Prefix:DR
First Name:BASHARAT
Middle Name:
Last Name:HUSSAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 BUDINGER AVENUE
Mailing Address - Street 2:STE A
Mailing Address - City:ST. CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-6007
Mailing Address - Country:US
Mailing Address - Phone:407-498-0056
Mailing Address - Fax:407-498-0057
Practice Address - Street 1:1600 BUDINGER AVENUE
Practice Address - Street 2:STE A
Practice Address - City:ST. CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6007
Practice Address - Country:US
Practice Address - Phone:407-498-0056
Practice Address - Fax:407-498-0057
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18350207RG0300X
FLME100447207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03222067Medicaid
MS110001758Medicare ID - Type Unspecified
MS03222067Medicaid