Healthcare Provider Details

I. General information

NPI: 1598956690
Provider Name (Legal Business Name): BASSAN & BLOOM M D S P L
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ALTON RD # 850
MIAMI BEACH FL
33140-2891
US

IV. Provider business mailing address

4302 ALTON RD # 850
MIAMI BEACH FL
33140-2891
US

V. Phone/Fax

Practice location:
  • Phone: 305-532-2999
  • Fax: 305-674-4803
Mailing address:
  • Phone: 305-532-2999
  • Fax: 305-674-4803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: ISAAC BASSAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 305-532-2999