Provider Demographics
NPI:1730574849
Name:ISSA, HUSSEIN ALI (MD)
Entity type:Individual
Prefix:
First Name:HUSSEIN
Middle Name:ALI
Last Name:ISSA
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 1:30400 TELEGRAPH RD STE 405
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-5817
Mailing Address - Country:US
Mailing Address - Phone:248-594-9501
Mailing Address - Fax:248-594-9426
Practice Address - Street 1:30400 TELEGRAPH RD STE 405
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025
Practice Address - Country:US
Practice Address - Phone:248-594-9501
Practice Address - Fax:248-594-9426
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301107266390200000X
MI4301117171207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program