1689649592 NPI number — DR. MALAIKA HAKIMA MD

Table of content: DR. MALAIKA HAKIMA MD (NPI 1689649592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689649592 NPI number — DR. MALAIKA HAKIMA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAKIMA
Provider First Name:
MALAIKA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689649592
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO DRAWER 1911
Provider Second Line Business Mailing Address:
1831 ROOSEVELT STREET
Provider Business Mailing Address City Name:
FLOMATON
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36441-1911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-296-0136
Provider Business Mailing Address Fax Number:
251-296-1916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PO DRAWER 1911
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLOMATON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36441-1911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-296-0136
Provider Business Practice Location Address Fax Number:
251-296-1916
Provider Enumeration Date:
02/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  12420 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 187817 . This is a "HEALTHEASE MEDICAID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 529905520 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051089471 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 058005800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 79961 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 101513 . This is a "HEALTH FIRST NETWORK/BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 000089471 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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