Provider Demographics
NPI:1043253602
Name:HAKKI HACKETTE, SAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:
Last Name:HAKKI HACKETTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:PROF
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:HAKKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 880
Mailing Address - Street 2:
Mailing Address - City:STERLING HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48311-0880
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27789 MOUND RD STE 100
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-2697
Practice Address - Country:US
Practice Address - Phone:313-209-3353
Practice Address - Fax:313-406-7255
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301104354207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI7592002OtherMEDICARE IDENTIFICATION NUMBER