Provider Demographics
NPI:1003935586
Name:MCGEHEE BOSIRE, KASSANDRA (MD)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:
Last Name:MCGEHEE BOSIRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KASSANDRA
Other - Middle Name:
Other - Last Name:MCGEHEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1100 E BROWARD BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2012
Mailing Address - Country:US
Mailing Address - Phone:954-463-5271
Mailing Address - Fax:
Practice Address - Street 1:1100 E BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2012
Practice Address - Country:US
Practice Address - Phone:954-463-5271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102422207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine