Provider Demographics
NPI:1558779652
Name:ABBAS AL-HAKIM
Entity Type:Organization
Organization Name:ABBAS AL-HAKIM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ABBAS
Authorized Official - Middle Name:MOHSEN
Authorized Official - Last Name:AL-HAKIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-913-5344
Mailing Address - Street 1:39020 SHORELINE DR.
Mailing Address - Street 2:
Mailing Address - City:HARRISON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48045
Mailing Address - Country:US
Mailing Address - Phone:586-913-5344
Mailing Address - Fax:
Practice Address - Street 1:468 CADIEUX
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE
Practice Address - State:MI
Practice Address - Zip Code:48230
Practice Address - Country:US
Practice Address - Phone:586-913-5344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072959207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty