Provider Demographics
NPI:1225090830
Name:HAKIM, MICHAEL H (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:H
Last Name:HAKIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:H
Other - Last Name:HAKIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:182 WEST ST
Mailing Address - Street 2:
Mailing Address - City:WARE
Mailing Address - State:MA
Mailing Address - Zip Code:01082-1442
Mailing Address - Country:US
Mailing Address - Phone:413-967-5562
Mailing Address - Fax:413-967-5567
Practice Address - Street 1:182 WEST ST
Practice Address - Street 2:
Practice Address - City:WARE
Practice Address - State:MA
Practice Address - Zip Code:01082-1442
Practice Address - Country:US
Practice Address - Phone:413-967-5562
Practice Address - Fax:413-967-5567
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219697207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2027721Medicaid
MA2027721Medicaid
MAA36259Medicare ID - Type Unspecified