Provider Demographics
NPI:1073049516
Name:KASSEM, KAMAL MOHAMED-AYED (MD)
Entity type:Individual
Prefix:
First Name:KAMAL
Middle Name:MOHAMED-AYED
Last Name:KASSEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 GATEWAY CTR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3927
Mailing Address - Country:US
Mailing Address - Phone:810-733-6480
Mailing Address - Fax:810-733-8740
Practice Address - Street 1:5100 GATEWAY CTR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3927
Practice Address - Country:US
Practice Address - Phone:810-733-6480
Practice Address - Fax:810-733-8740
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY53759207R00000X
MI4301509574207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology