Provider Demographics
NPI:1770729774
Name:HAKIM, FAYAZ AHMAD (MD)
Entity type:Individual
Prefix:
First Name:FAYAZ
Middle Name:AHMAD
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:PO BOX 636388
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6388
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3399 POLLOCK RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8395
Practice Address - Country:US
Practice Address - Phone:810-606-7550
Practice Address - Fax:810-606-6235
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN53571207R00000X
AZ44223207RC0000X
OH35.140382207RC0000X
390200000X
MI4301512775207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ717371Medicaid
MNENROLLEDMedicaid
MNP00992463OtherRAILROAD MEDICARE
IAENROLLEDMedicaid
MN110014081Medicare PIN