Provider Demographics
NPI:1891887535
Name:HAKIM, HISHAM (MDMPH)
Entity Type:Individual
Prefix:
First Name:HISHAM
Middle Name:
Last Name:HAKIM
Suffix:
Gender:M
Credentials:MDMPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 HUGH DANIEL DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-7148
Mailing Address - Country:US
Mailing Address - Phone:205-991-3300
Mailing Address - Fax:205-991-3327
Practice Address - Street 1:7500 HUGH DANIEL DR
Practice Address - Street 2:SUITE 250
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-7148
Practice Address - Country:US
Practice Address - Phone:205-991-3300
Practice Address - Fax:205-991-3327
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14336174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051089200OtherBCBS
AL051095118OtherBCBS
AL00996330Medicaid
ALC74452Medicare UPIN
AL000089200Medicare ID - Type Unspecified