Provider Demographics
NPI:1598061129
Name:PHILIP, BASSEM (MD)
Entity type:Individual
Prefix:
First Name:BASSEM
Middle Name:
Last Name:PHILIP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 947407
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-7407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:14405 ARBOR GREEN TRL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-8409
Practice Address - Country:US
Practice Address - Phone:941-917-7080
Practice Address - Fax:941-917-7085
Is Sole Proprietor?:No
Enumeration Date:2011-01-29
Last Update Date:2021-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME110747207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004363700Medicaid
FL14H47OtherBCBS
FL14H47OtherBCBS