Healthcare Provider Details

I. General information

NPI: 1205246709
Provider Name (Legal Business Name): HISHAK HAKIM M.D., M.P.H., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 MEDICAL PARK OFC PARK
TALLADEGA AL
35160-2213
US

IV. Provider business mailing address

7500 HUGH DANIEL DR SUITE 250
BIRMINGHAM AL
35242-7148
US

V. Phone/Fax

Practice location:
  • Phone: 256-362-7009
  • Fax: 256-362-0190
Mailing address:
  • Phone: 205-991-3300
  • Fax: 205-991-3327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number14336
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number14336
License Number StateAL

VIII. Authorized Official

Name: HISHAM HAKIM
Title or Position: PHYSICIAN/OWNER
Credential: M.D., M.P.H.
Phone: 205-991-3300