Provider Demographics
NPI:1528617222
Name:AVICENNA HOSPITAL MEDICINE, LLC
Entity type:Organization
Organization Name:AVICENNA HOSPITAL MEDICINE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KAAKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA, FACP
Authorized Official - Phone:479-926-9426
Mailing Address - Street 1:3019 BRIGHTON PT
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5477
Mailing Address - Country:US
Mailing Address - Phone:833-284-2362
Mailing Address - Fax:479-777-7123
Practice Address - Street 1:3019 BRIGHTON PT
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5477
Practice Address - Country:US
Practice Address - Phone:833-284-2362
Practice Address - Fax:479-777-7123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-05
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty