Healthcare Provider Details

I. General information

NPI: 1235426073
Provider Name (Legal Business Name): DR. IBRAHIM IBRAHIM I HAKAMI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

100 FOREST PL P15
OAK PARK IL
60301-1145
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-2273
  • Fax:
Mailing address:
  • Phone: 312-532-9066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125060093
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: