Healthcare Provider Details

I. General information

NPI: 1124714514
Provider Name (Legal Business Name): CARDIOVASCULAR CLINIC OF ARIZONA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2157 E BASELINE RD STE 101
TEMPE AZ
85283-1544
US

IV. Provider business mailing address

2157 E BASELINE RD STE 101
TEMPE AZ
85283-1544
US

V. Phone/Fax

Practice location:
  • Phone: 480-992-4344
  • Fax: 480-422-9154
Mailing address:
  • Phone: 480-992-4344
  • Fax: 480-422-9154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: THASLIM KASSIM
Title or Position: CEO
Credential: MD
Phone: 240-603-2177