Provider Demographics
NPI:1669439600
Name:HOSSAIN, IMTIAZ (MD)
Entity type:Individual
Prefix:
First Name:IMTIAZ
Middle Name:
Last Name:HOSSAIN
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 1:101 CLEARWATER-LARGO RD N #2
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2357
Mailing Address - Country:US
Mailing Address - Phone:727-588-0366
Mailing Address - Fax:727-588-0370
Practice Address - Street 1:101 CLEARWATER-LARGO RD N #2
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2357
Practice Address - Country:US
Practice Address - Phone:727-588-0366
Practice Address - Fax:727-588-0370
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70148207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE0067ZMedicare ID - Type Unspecified
FLG61656Medicare UPIN