Healthcare Provider Details

I. General information

NPI: 1740290444
Provider Name (Legal Business Name): ROGER EDMOND HAKIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 NORTON AVE
BARBERTON OH
44203-1932
US

IV. Provider business mailing address

256 NORTON AVE
BARBERTON OH
44203-1932
US

V. Phone/Fax

Practice location:
  • Phone: 330-753-2289
  • Fax: 330-753-2280
Mailing address:
  • Phone: 330-753-2289
  • Fax: 330-753-2280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number35-028856
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: