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General NPI Number Information
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NPI Number | 1275152159
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Entity Type | Individual
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Provider Name | MOHAMMED MUSHTAQ AHMED HAKIM
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Gender | Male
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Dates
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Enumeration Date | 04/10/2020
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 205 N EAST AVE
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City | JACKSON
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State | MI
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Zip | 49201-1753
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Country | US
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Telephone | 517-205-7836
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Fax |
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Provider Business Mailing Address
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Address Line | 451 E TOWN ST APT 209
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City | COLUMBUS
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State | OH
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Zip | 43215-4724
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Country | US
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Telephone | 614-680-2552
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 4301514464
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 4301514464
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License Number State | MI
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