Provider Demographics
NPI:1811993413
Name:HUSAIN, ISHRAT (MD)
Entity type:Individual
Prefix:MR
First Name:ISHRAT
Middle Name:
Last Name:HUSAIN
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 1:1050 ISAAC STREETS DR
Mailing Address - Street 2:SUITE 131
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3291
Mailing Address - Country:US
Mailing Address - Phone:419-690-0888
Mailing Address - Fax:419-690-8228
Practice Address - Street 1:1050 ISAAC STREETS DR
Practice Address - Street 2:SUITE 131
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3291
Practice Address - Country:US
Practice Address - Phone:419-690-0888
Practice Address - Fax:419-690-8228
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049280208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01324OtherPARAMOUNT
OH0559122Medicaid
OHIS0881262Medicare ID - Type Unspecified
A15579Medicare UPIN