Provider Demographics
NPI:1518029354
Name:BA'ALBAKI, HISHAM A (MD)
Entity Type:Individual
Prefix:MR
First Name:HISHAM
Middle Name:A
Last Name:BA'ALBAKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:201 E DR HICKS BLVD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-5767
Mailing Address - Country:US
Mailing Address - Phone:256-766-8570
Mailing Address - Fax:256-766-5183
Practice Address - Street 1:201 E DR HICKS BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5767
Practice Address - Country:US
Practice Address - Phone:256-766-8570
Practice Address - Fax:256-766-5183
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15196207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115631Medicaid
AL051083040OtherBCBS AL
060037833OtherPALMETTO GBA RR MEDICARE
AL51591202OtherBCBS
TN30106466OtherBCBS TN
TN4013718Medicaid
AL51591403OtherBCBS
51519601OtherHEALTHSPRING OF AL
AL51591203OtherBCBS
AL000083040Medicaid
2510156OtherUNITED HEALTHCARE
AL000083040Medicaid
51519601OtherHEALTHSPRING OF AL