Provider Demographics
NPI:1902048572
Name:WAKIM, NADINE J (MD)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:J
Last Name:WAKIM
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 1:294 UPTOWN BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-3536
Mailing Address - Country:US
Mailing Address - Phone:972-293-6300
Mailing Address - Fax:
Practice Address - Street 1:294 UPTOWN BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-3536
Practice Address - Country:US
Practice Address - Phone:972-293-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-29
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1431208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics