Provider Demographics
NPI:1083688725
Name:HAK, KAZEM (MD)
Entity Type:Individual
Prefix:DR
First Name:KAZEM
Middle Name:
Last Name:HAK
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 1:3400 FLECKENSTEIN RD STE 2
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3042
Mailing Address - Country:US
Mailing Address - Phone:810-230-9323
Mailing Address - Fax:810-230-9328
Practice Address - Street 1:3400 FLECKENSTEIN RD
Practice Address - Street 2:SUITE 3
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3043
Practice Address - Country:US
Practice Address - Phone:810-230-9323
Practice Address - Fax:810-230-9328
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067151207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4371320Medicaid
MI0N83640Medicare ID - Type Unspecified
MIG33849Medicare UPIN