Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 4301104354 | MI |
NPI | 1043253602 |
---|---|
Provider Name | Dr. Sam Hakki Hackette |
First Address | Sterling Hts, MI 48311-0880 |
Second Address | Warren, MI 48092-2697 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 30/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MI7592002 | MEDICARE IDENTIFICATION NUMBER (01) | MI |