Provider Demographics
NPI:1598287914
Name:KAKOS, FADEE RAMZI (DPM)
Entity Type:Individual
Prefix:DR
First Name:FADEE
Middle Name:RAMZI
Last Name:KAKOS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29417 BRENTWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2223
Mailing Address - Country:US
Mailing Address - Phone:248-789-6119
Mailing Address - Fax:
Practice Address - Street 1:15830 FORT ST STE 8
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1348
Practice Address - Country:US
Practice Address - Phone:734-281-6320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002677213E00000X
MI5901400364213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist