Provider Demographics
NPI:1538187190
Name:AL-GHUSSAIN, EMAD (MD)
Entity type:Individual
Prefix:DR
First Name:EMAD
Middle Name:
Last Name:AL-GHUSSAIN
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:PO BOX 17000
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-7000
Mailing Address - Country:US
Mailing Address - Phone:479-314-5175
Mailing Address - Fax:479-314-5185
Practice Address - Street 1:7301 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4100
Practice Address - Country:US
Practice Address - Phone:479-314-5175
Practice Address - Fax:479-314-5185
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0339208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5J653OtherAR BCBS
OK100061920DMedicaid
AR127528001Medicaid
AR127528001Medicaid
F99863Medicare UPIN