Provider Demographics
NPI:1447332705
Name:HUSSAIN, OMAR (DO)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:HUSSAIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7607 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-3513
Mailing Address - Country:US
Mailing Address - Phone:708-450-4557
Mailing Address - Fax:708-338-0200
Practice Address - Street 1:675 W NORTH AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1634
Practice Address - Country:US
Practice Address - Phone:708-450-4557
Practice Address - Fax:708-338-0200
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36111662207RP1001X, 207RS0012X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31601838OtherBLUE CROSS BLUE SHIELD
IL31601838OtherBLUE CROSS BLUE SHIELD
IL202963Medicare PIN
ILVAD000Medicare UPIN