MEDICARE: DR. FADEE RAMZI KAKOS DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	5901002677	MI
2	213E00000X	Podiatrist	5901400364	MI

General Provider Information

NPI Number	:	1598287914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FADEE RAMZI KAKOS DPM

Provider Business Mailing Address
First Line	:	29417 BRENTWOOD ST
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-2223
Country	:	US
Telephone Number	:	248-789-6119
Fax Number	:

Provider Business Practice Location Address
First Line	:	15830 FORT ST STE 8
Second Line	:
City	:	SOUTHGATE
State	:	MI
Zip	:	48195-1348
Country	:	US
Telephone Number	:	734-281-6320
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2017
Last Update Date	:	06/25/2020

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