Healthcare Provider Details

I. General information

NPI: 1669632683
Provider Name (Legal Business Name): HUSSEIN A KASSAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNM DEPT OF INTERNAL MEDICINE MSC10 5550, 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131
US

IV. Provider business mailing address

UNM DEPT OF INTERNAL MEDICINE MSC10 5550, 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4661
  • Fax:
Mailing address:
  • Phone: 505-272-4661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberRS2009-0340
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036.129197
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number26390
License Number StateOK
# 4
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: