MEDICARE: MR. ANTHONY S KASSAB

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
1	251E00000X	Home Health Agency
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1386290674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY S KASSAB

Provider Business Mailing Address
First Line	:	31201 CHICAGO RD S STE C101
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48093-5523
Country	:	US
Telephone Number	:	248-687-4768
Fax Number	:

Provider Business Practice Location Address
First Line	:	31201 CHICAGO RD S STE C101
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48093-5523
Country	:	US
Telephone Number	:	248-687-4768
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2019
Last Update Date	:	02/24/2021

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Directions to “ MR. ANTHONY S KASSAB ” Practice Location

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