Healthcare Provider Details

I. General information

NPI: 1942695853
Provider Name (Legal Business Name): IHAB KASSAB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26850 PROVIDENCE PKWY STE 350
NOVI MI
48374-1261
US

IV. Provider business mailing address

26850 PROVIDENCE PKWY STE 350
NOVI MI
48374-1261
US

V. Phone/Fax

Practice location:
  • Phone: 248-662-4110
  • Fax: 248-662-4120
Mailing address:
  • Phone: 248-662-4110
  • Fax: 248-662-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number4301115458
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301115458
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: