| Name: | Hisham Hakim, M.D., M.P.H., P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 07 Jan 1994 (31 years ago) (Companies founded in January 1994) |
| Date of dissolution: | 07 Oct 2019 |
| Entity Number: | 000-161-346 |
| Register Number: | 000161346 |
| ZIP code: | 35150 (Companies in Talladega, 35150) |
| County: | Talladega |
| Place of Formation: | Talladega County |
| Principal Address: | SYLACAUGA, AL |
| Registered Office Street Address: | 122 SOUTH ANNISTON AVESYLACAUGA, AL 35150 |
| Authorized Capital: | $2,000 |
| Paid Share Capital: | $2,000 |
Activities
PRACTICE THE PROFESSION OF DOCTOR OF MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871903427 | 2014-05-05 | 2014-05-06 | 7500 HUGH DANIEL DR, SUITE 250, BIRMINGHAM, AL, 352427148, US | 234 N BROADWAY AVE, SYLACAUGA, AL, 351502526, US | |||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 205-991-3300 |
| Fax | 2059913327 |
| Phone | +1 256-249-5500 |
| Fax | 2562495506 |
Authorized person
| Name | HISHAM HAKIM |
| Role | PHYSICIAN/OWNER |
| Phone | 2059913300 |
Taxonomy
| Taxonomy Code | 261QH0100X - Health Service Clinic/Center |
| License Number | 14336 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE |
| Number | 000089200 |
| State | AL |
| Issuer | BCBS |
| Number | 051095117 |
| State | AL |
| Issuer | BCBS |
| Number | 051095118 |
| Issuer | MEDICAID |
| Number | 00996330 |
| State | AL |
| Name | Role |
|---|---|
| HAKIM, HISHAM | Agent |
| Name | Role |
|---|---|
| HAKIM, HISHAM | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
