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NPI Code Detail

MEDICARE: OMAR R. KASSEM MD

MEDICARE: OMAR R. KASSEM MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician20079WV
2207Q00000XFamily Medicine Physician14136TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295841054
Entity Type Code : Individual
Provider Name (Legal Business Name) : OMAR R. KASSEM MD
Provider Business Mailing Address
First Line : PO BOX 850
Second Line :
City : ROGERSVILLE
State : TN
Zip : 37857-0850
Country : US
Telephone Number : 423-272-9163
Fax Number : 423-921-6920
Provider Business Practice Location Address
First Line : 4307 HIGHWAY 66 S
Second Line :
City : ROGERSVILLE
State : TN
Zip : 37857-3155
Country : US
Telephone Number : 423-921-1600
Fax Number : 423-921-6920
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2006
Last Update Date : 01/05/2016

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