Provider Demographics
NPI:1730380023
Name:HUSSAIN, AMENA (MD)
Entity type:Individual
Prefix:DR
First Name:AMENA
Middle Name:
Last Name:HUSSAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMENA
Other - Middle Name:
Other - Last Name:HUSSAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1820 PRESTON PARK BLVD
Mailing Address - Street 2:SUITE 1450
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093
Mailing Address - Country:US
Mailing Address - Phone:469-800-4540
Mailing Address - Fax:469-800-4541
Practice Address - Street 1:1820 PRESTON PARK BLVD
Practice Address - Street 2:SUITE 1450
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:469-800-4540
Practice Address - Fax:469-800-4541
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0939207RC0001X
NJ25MA08684600207RC0000X
MDD66137208M00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD013752900Medicaid
TX393200TYKTPMedicare PIN
MD013752900Medicaid