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General NPI Number Information
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NPI Number | 1871698597
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Entity Type | Individual
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Provider Name | JONATHAN I HAKIM MD
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Gender | Male
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 11/04/2016
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Provider Practice Location Address
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Address Line | 550 OSBORN BLVD SUITE 1006
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City | SAULT SAINTE MARIE
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State | MI
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Zip | 49783-1899
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Country | US
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Telephone | 906-253-2620
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Fax | 906-253-2639
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Provider Business Mailing Address
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Address Line | 550 OSBORN BLVD SUITE 1006
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City | SAULT SAINTE MARIE
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State | MI
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Zip | 49783-1899
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Country | US
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Telephone | 906-253-2620
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Fax | 906-253-2639
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | MD434561
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 4301088941
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License Number State | MI
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