Provider Demographics
NPI:1144660440
Name:HUSSAIN, FATIMA (MD)
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:
Last Name:HUSSAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 W MADISON ST STE 4550
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-4636
Mailing Address - Country:US
Mailing Address - Phone:312-641-2586
Mailing Address - Fax:
Practice Address - Street 1:181 W MADISON ST STE 4550
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-4636
Practice Address - Country:US
Practice Address - Phone:312-641-2586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-45570207Q00000X
NH19174207Q00000X
AZ57277207Q00000X
MN64519207Q00000X
COCDR.0000196207Q00000X
NE31177207Q00000X
KS04-41426207Q00000X
WV28467207Q00000X
WI234-320207Q00000X
ND15969207Q00000X
MDD88183207Q00000X
IL036.139995207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine