MEDICARE: MICHAEL J KASSOUF 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	2086S0129X	Vascular Surgery Physician	136722	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	136722-1	OTHER	NY	MED LICENSE

General Provider Information

NPI Number	:	1609812528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL J KASSOUF MD

Provider Business Mailing Address
First Line	:	346 76TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-3106
Country	:	US
Telephone Number	:	718-238-0131
Fax Number	:	718-833-9595

Provider Business Practice Location Address
First Line	:	346 76TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-3106
Country	:	US
Telephone Number	:	718-238-0131
Fax Number	:	718-833-9595

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

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	11/12/2010

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