MEDICARE: DR. BASSIM KOBROSSY M.D.

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	207RH0003X	Hematology & Oncology Physician	35516	IA
2	207RX0202X	Medical Oncology Physician	17244	ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639169675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BASSIM KOBROSSY M.D.

Provider Business Mailing Address
First Line	:	1702 UNIVERSITY DR S
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58103-4940
Country	:	US
Telephone Number	:	701-364-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1702 UNIVERSITY DR S
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58103-4940
Country	:	US
Telephone Number	:	701-364-3300
Fax Number	:	701-536-4189

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	05/12/2021

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