Provider Demographics
NPI:1699055566
Name:ALHAKIM, MANAL (MD)
Entity type:Individual
Prefix:
First Name:MANAL
Middle Name:
Last Name:ALHAKIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 S DOBSON RD STE 218
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4754
Mailing Address - Country:US
Mailing Address - Phone:480-626-8737
Mailing Address - Fax:
Practice Address - Street 1:1520 S DOBSON RD STE 218
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4754
Practice Address - Country:US
Practice Address - Phone:480-626-8737
Practice Address - Fax:480-704-4698
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR72910207R00000X
AZ49716207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR72910OtherTRAINING PERMIT