Provider Demographics
NPI:1841270469
Name:HAKIM, HASAN B (MD)
Entity type:Individual
Prefix:
First Name:HASAN
Middle Name:B
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 1:6425 SCHAEFER RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2212
Mailing Address - Country:US
Mailing Address - Phone:313-581-3888
Mailing Address - Fax:
Practice Address - Street 1:6425 SCHAEFER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2212
Practice Address - Country:US
Practice Address - Phone:313-581-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1071368207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1071368OtherSTATE LICENSE
MI103407965Medicaid
MI1071368OtherSTATE LICENSE
MIE54628Medicare UPIN