Provider Demographics
NPI:1225245178
Name:FAKHRI, HESHAM ALI ABDELKADER (MD)
Entity Type:Individual
Prefix:
First Name:HESHAM
Middle Name:ALI ABDELKADER
Last Name:FAKHRI
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 1:301 W PLATT ST STE A428
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2292
Mailing Address - Country:US
Mailing Address - Phone:813-708-8346
Mailing Address - Fax:866-270-9831
Practice Address - Street 1:508 S HABANA AVE STE 160
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4190
Practice Address - Country:US
Practice Address - Phone:813-708-8346
Practice Address - Fax:866-270-9831
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107116207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003758100Medicaid
FLFC644XMedicare PIN