Provider Demographics
NPI:1104453802
Name:HAKIM, AMANDA AMEN (MD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:AMEN
Last Name:HAKIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMAND
Other - Middle Name:AMIRA
Other - Last Name:AMEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:237 HEATHERPOINT DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-3902
Mailing Address - Country:US
Mailing Address - Phone:313-720-9777
Mailing Address - Fax:
Practice Address - Street 1:1324 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4543
Practice Address - Country:US
Practice Address - Phone:313-720-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2024-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FL163363207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program