Provider Demographics
NPI:1871239053
Name:HUSSAIN, MOHAMMED WAJID
Entity type:Individual
Prefix:
First Name:MOHAMMED WAJID
Middle Name:
Last Name:HUSSAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 N 3RD STREET CREIGHTON UNIVERSITY
Mailing Address - Street 2:SUITE 290
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012
Mailing Address - Country:US
Mailing Address - Phone:602-812-3132
Mailing Address - Fax:
Practice Address - Street 1:ST. JOSEPH'S HOSPITAL AND MEDICAL CENTER
Practice Address - Street 2:350 W THOMAS RD
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013
Practice Address - Country:US
Practice Address - Phone:602-406-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-12-29
Deactivation Date:2022-12-21
Deactivation Code:
Reactivation Date:2022-12-29
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program