Healthcare Provider Details

I. General information

NPI: 1093114761
Provider Name (Legal Business Name): AHMED HAKIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 W 7 MILE RD
DETROIT MI
48203-1967
US

IV. Provider business mailing address

43825 MICHIGAN AVE
CANTON MI
48188-2551
US

V. Phone/Fax

Practice location:
  • Phone: 313-893-6172
  • Fax:
Mailing address:
  • Phone: 734-397-3088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401014987
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: