Healthcare Provider Details

I. General information

NPI: 1578731733
Provider Name (Legal Business Name): BASSAM SAYEGH MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 CHIMNEY CORNER LN SUITE 1026
JUPITER FL
33458-4800
US

IV. Provider business mailing address

224 CHIMNEY CORNER LN SUITE 1026
JUPITER FL
33458-4800
US

V. Phone/Fax

Practice location:
  • Phone: 561-743-7766
  • Fax: 561-748-0117
Mailing address:
  • Phone: 561-743-7766
  • Fax: 561-748-0117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME76049
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME76049
License Number State

VIII. Authorized Official

Name: BASSAM SAYEGH
Title or Position: PRESIDENT CORP
Credential: MD
Phone: 561-743-7766