Provider Demographics
NPI:1144450230
Name:BASHARAT HUSSAIN MD PA
Entity type:Organization
Organization Name:BASHARAT HUSSAIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BASHARAT
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-498-0056
Mailing Address - Street 1:1600 BUDINGER AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-6008
Mailing Address - Country:US
Mailing Address - Phone:407-498-0056
Mailing Address - Fax:407-498-0057
Practice Address - Street 1:1600 BUDINGER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6008
Practice Address - Country:US
Practice Address - Phone:407-498-0056
Practice Address - Fax:407-498-0057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 100447207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME 100447OtherMEDICAL LICENSE