Provider Demographics
NPI:1205246709
Name:HISHAK HAKIM M.D., M.P.H., P.C.
Entity type:Organization
Organization Name:HISHAK HAKIM M.D., M.P.H., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HISHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:205-991-3300
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 1:202 MEDICAL PARK OFC PARK
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2213
Practice Address - Country:US
Practice Address - Phone:256-362-7009
Practice Address - Fax:256-362-0190
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HISHAM HAKIM, M.D., M.P.H., P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14336261QP3300X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051095117OtherBCBS
AL00996330Medicaid
AL051095118OtherBCBS
AL051095118OtherBCBS
AL00996330Medicaid