Provider Demographics
NPI:1851394134
Name:SAFADI, HAKAM H (MD)
Entity Type:Individual
Prefix:
First Name:HAKAM
Middle Name:H
Last Name:SAFADI
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 1:8909 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7039
Mailing Address - Country:US
Mailing Address - Phone:219-769-0054
Mailing Address - Fax:219-769-1793
Practice Address - Street 1:8909 BROADWAY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7039
Practice Address - Country:US
Practice Address - Phone:219-769-0054
Practice Address - Fax:219-769-1793
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029166A207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
0591755OtherAETNA
IL000000086614OtherANTHEM/BCBS
020024000OtherBLACK LUNG GROUP#
IN100212570Medicaid
0591755OtherAETNA
IN704030BMedicare ID - Type Unspecified
INB28930Medicare UPIN