Provider Demographics
NPI:1740290444
Name:HAKIM, ROGER EDMOND (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:EDMOND
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 1:256 NORTON AVE
Mailing Address - Street 2:
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-1932
Mailing Address - Country:US
Mailing Address - Phone:330-753-2289
Mailing Address - Fax:330-753-2280
Practice Address - Street 1:256 NORTON AVE
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-1932
Practice Address - Country:US
Practice Address - Phone:330-753-2289
Practice Address - Fax:330-753-2280
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-028856305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization