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General NPI Number Information
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NPI Number | 1407089923
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Entity Type | Individual
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Provider Name | ANGEL BASSUK MD
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Gender | Male
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Dates
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Enumeration Date | 09/01/2009
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Last Update Date | 09/01/2009
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Provider Practice Location Address
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Address Line | 9655 WOODS DR
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City | SKOKIE
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State | IL
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Zip | 60077-4418
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Country | US
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Telephone | 727-460-4353
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Fax |
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Provider Business Mailing Address
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Address Line | 90 KELLEYS TRL
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City | OLDSMAR
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State | FL
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Zip | 34677-1976
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Country | US
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Telephone | 727-460-4353
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | 036-051092
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License Number State | IL
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