Healthcare Provider Details

I. General information

NPI: 1235824319
Provider Name (Legal Business Name): FARES KASEM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MCKINLEY PARK DR
MARION OH
43302-6399
US

IV. Provider business mailing address

1000 MCKINLEY PARK DR
MARION OH
43302-6399
US

V. Phone/Fax

Practice location:
  • Phone: 740-383-8400
  • Fax:
Mailing address:
  • Phone: 740-383-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number34.018474
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: