Provider Demographics
NPI:1588783427
Name:HUSAIN, SYED ISHRAT (DR, CSA)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:ISHRAT
Last Name:HUSAIN
Suffix:
Gender:M
Credentials:DR, CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 N PRAIRIE DR
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-3148
Mailing Address - Country:US
Mailing Address - Phone:847-452-2918
Mailing Address - Fax:
Practice Address - Street 1:1121 LAKE COOK RD
Practice Address - Street 2:SUITE M
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5650
Practice Address - Country:US
Practice Address - Phone:847-945-4570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist