Provider Demographics
NPI:1992350284
Name:KASSEM, MOHAMMED MEDHAT (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:MEDHAT
Last Name:KASSEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1650 SELWYN AVE APT 4A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-7628
Mailing Address - Country:US
Mailing Address - Phone:718-960-1216
Mailing Address - Fax:
Practice Address - Street 1:5000 KY ROUTE 321
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-9113
Practice Address - Country:US
Practice Address - Phone:606-886-7645
Practice Address - Fax:606-889-6206
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY59988208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery