Provider Demographics
NPI:1730177114
Name:KAKISH, HUMAM BASSAM (MD)
Entity type:Individual
Prefix:MR
First Name:HUMAM
Middle Name:BASSAM
Last Name:KAKISH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7515 GREENVILLE AVE STE 706
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3885
Mailing Address - Country:US
Mailing Address - Phone:469-547-1142
Mailing Address - Fax:469-547-1162
Practice Address - Street 1:7515 GREENVILLE AVE STE 706
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3885
Practice Address - Country:US
Practice Address - Phone:469-547-1142
Practice Address - Fax:469-547-1162
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2024-07-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK08532086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G19502Medicare UPIN