Healthcare Provider Details

I. General information

NPI: 1396231890
Provider Name (Legal Business Name): GASSAN KASSIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2018
Last Update Date: 07/18/2025
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ DIV IM GASTROENTEROLOGY
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-2066
  • Fax: 314-362-2357
Mailing address:
  • Phone: 314-747-2066
  • Fax: 314-362-2357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2025016144
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2025016144
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: