MEDICARE: BASSEM MORA 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
1	207P00000X	Emergency Medicine Physician	036-113451	IL
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	58638	MN
3	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	ME125597	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1578659611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BASSEM MORA MD

Provider Business Mailing Address
First Line	:	2501 N ORANGE AVE STE 442
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4644
Country	:	US
Telephone Number	:	407-303-3692
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 N ORANGE AVE STE 442
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4644
Country	:	US
Telephone Number	:	407-303-3692
Fax Number	:

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	11/06/2023

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Directions to “ BASSEM MORA MD” Practice Location

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