Provider Demographics
NPI:1104099456
Name:BARSOUM, BASIEM WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:BASIEM
Middle Name:WILLIAM
Last Name:BARSOUM
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 1:2100 OCOEE APOPKA RD STE 120
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-9210
Mailing Address - Country:US
Mailing Address - Phone:078-889-1930
Mailing Address - Fax:407-889-1904
Practice Address - Street 1:2100 OCOEE APOPKA RD STE 120
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-9210
Practice Address - Country:US
Practice Address - Phone:078-889-1930
Practice Address - Fax:407-889-1904
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110311207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL03847600Medicaid
FLFD128WMedicare PIN
FLFD128ZMedicare PIN