MEDICARE: BASSEM REZK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	TPPA961	FL
2	363A00000X	Physician Assistant	2022027022	MO
3	390200000X	Student in an Organized Health Care Education/Training Program	R79181	AZ

General Provider Information

NPI Number	:	1487372314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BASSEM REZK

Provider Business Mailing Address
First Line	:	22010 N 73RD LN
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85310-5297
Country	:	US
Telephone Number	:	929-308-5775
Fax Number	:

Provider Business Practice Location Address
First Line	:	3515 W UNION HILLS DR STE 111
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-2430
Country	:	US
Telephone Number	:	929-308-5775
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2022
Last Update Date	:	06/16/2025

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Directions to “ BASSEM REZK ” Practice Location

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