Provider Demographics
NPI:1790731750
Name:HAKIM, ISHRAT (MD)
Entity Type:Individual
Prefix:
First Name:ISHRAT
Middle Name:
Last Name:HAKIM
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 1:18700 N 64TH DR
Mailing Address - Street 2:STE 312
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7114
Mailing Address - Country:US
Mailing Address - Phone:623-566-4718
Mailing Address - Fax:623-566-4820
Practice Address - Street 1:18700 N 64TH DR
Practice Address - Street 2:STE 312
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7114
Practice Address - Country:US
Practice Address - Phone:623-566-4718
Practice Address - Fax:623-566-4820
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30156207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ687030Medicaid
70296Medicare ID - Type Unspecified
AZ687030Medicaid