Healthcare Provider Details

I. General information

NPI: 1225245178
Provider Name (Legal Business Name): HESHAM ALI ABDELKADER FAKHRI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 S HABANA AVE STE 160
TAMPA FL
33609-4190
US

IV. Provider business mailing address

301 W PLATT ST STE A428
TAMPA FL
33606-2292
US

V. Phone/Fax

Practice location:
  • Phone: 813-708-8346
  • Fax: 866-270-9831
Mailing address:
  • Phone: 813-708-8346
  • Fax: 866-270-9831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME107116
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME107116
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: