Healthcare Provider Details

I. General information

NPI: 1689170219
Provider Name (Legal Business Name): FAHAD HAWK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 PINELLAS ST STE 400
CLEARWATER FL
33756-3356
US

IV. Provider business mailing address

PO BOX 917770
ORLANDO FL
32891-0001
US

V. Phone/Fax

Practice location:
  • Phone: 727-445-1912
  • Fax:
Mailing address:
  • Phone: 813-821-8038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME148553
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: