Healthcare Provider Details

I. General information

NPI: 1780948299
Provider Name (Legal Business Name): KASSEM BOURGI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 THOMPSON LN
NASHVILLE TN
37204-3616
US

IV. Provider business mailing address

PO BOX 31609
BELFAST ME
04915-0169
US

V. Phone/Fax

Practice location:
  • Phone: 615-499-7406
  • Fax: 833-968-2944
Mailing address:
  • Phone: 615-499-7406
  • Fax: 833-968-2944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301100453
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number71966
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number01080959A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number71966
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: