Provider Demographics
NPI:1194816389
Name:HAKKI, AHADI (MD)
Entity Type:Individual
Prefix:
First Name:AHADI
Middle Name:
Last Name:HAKKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ABDUL
Other - Middle Name:HADI ISMAIL
Other - Last Name:HAKKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1302 FRANKLIN AVE STE 4500
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-3593
Mailing Address - Country:US
Mailing Address - Phone:309-556-8300
Mailing Address - Fax:309-556-8293
Practice Address - Street 1:1302 FRANKLIN AVE STE 4500
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3593
Practice Address - Country:US
Practice Address - Phone:309-556-8300
Practice Address - Fax:309-556-8300
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0048511208G00000X
IL036144491208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065177000Medicaid
FLE17813Medicare UPIN
FL065177000Medicaid