Provider Demographics
NPI:1962459065
Name:HAKAMI, NASROLLAH (MD)
Entity Type:Individual
Prefix:
First Name:NASROLLAH
Middle Name:
Last Name:HAKAMI
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:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:1101 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-882-3961
Practice Address - Fax:573-884-4277
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4453208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS2086908001OtherKANSAS MEDICAID
MO6358OtherBLUE SHIELD/BLUE CHOICE
MO200527505Medicaid
MO102491OtherHEALTHLINK
MO7509120OtherUNITED HEALTHCARE
KS2086908001OtherKANSAS MEDICAID
MO086010635Medicare PIN
MO6358OtherBLUE SHIELD/BLUE CHOICE
MO102491OtherHEALTHLINK