Provider Demographics
NPI:1871786566
Name:HUSSEIN, HANAN (MD)
Entity type:Individual
Prefix:DR
First Name:HANAN
Middle Name:
Last Name:HUSSEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 W LEAGUE CITY PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-7078
Mailing Address - Country:US
Mailing Address - Phone:281-525-6290
Mailing Address - Fax:832-905-6173
Practice Address - Street 1:1507 W LEAGUE CITY PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-7078
Practice Address - Country:US
Practice Address - Phone:281-525-6290
Practice Address - Fax:832-905-6173
Is Sole Proprietor?:No
Enumeration Date:2007-08-25
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9365207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188645902Medicaid
TX8L11713Medicare PIN
TXCI5830Medicare PIN
TX00R518Medicare PIN
TX8J8787Medicare PIN
TX188645902Medicaid
TXP00432016Medicare PIN