Provider Demographics
NPI:1841383304
Name:HAKIM, FARES S (MD)
Entity Type:Individual
Prefix:
First Name:FARES
Middle Name:S
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 1:4828 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2341
Mailing Address - Country:US
Mailing Address - Phone:850-477-8109
Mailing Address - Fax:850-478-2412
Practice Address - Street 1:26901 BEAUMONT BLVD STE 3D
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-3849
Practice Address - Country:US
Practice Address - Phone:947-522-0688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101227714207RG0100X
FLME81200207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
100014631OtherRAILROAD MEDICARE
FL259729200Medicaid
AL009937070Medicaid
FL51643OtherBCBS OF FLORIDA
0494478OtherCIGNA
7940192OtherAETNA
001996645001OtherUNITED HEALTH CARE
AL059027297OtherBCBS OF ALABAMA
A954OtherHEALTH OPTIONS
FL259729200Medicaid
AL009937070Medicaid