Provider Demographics
NPI:1699741637
Name:HUSSAIN, SYED (MD)
Entity type:Individual
Prefix:
First Name:SYED
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 1:910 S BRYAN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6615
Mailing Address - Country:US
Mailing Address - Phone:956-519-3523
Mailing Address - Fax:956-585-3328
Practice Address - Street 1:910 S BRYAN RD STE 103
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6615
Practice Address - Country:US
Practice Address - Phone:956-519-3523
Practice Address - Fax:956-585-3328
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1157207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX011736332Medicaid
TX8F7012OtherBLUECROSS BLUESHIELD
TXD06801Medicare UPIN
TX8F7012OtherBLUECROSS BLUESHIELD
613486Medicare PIN