Provider Demographics
NPI:1245222769
Name:KASSIR, ANDREW A (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:A
Last Name:KASSIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8415 N PIMA RD
Mailing Address - Street 2:SUITE 288
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4480
Mailing Address - Country:US
Mailing Address - Phone:480-947-3533
Mailing Address - Fax:480-947-3531
Practice Address - Street 1:8415 N PIMA RD
Practice Address - Street 2:SUITE 288
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4480
Practice Address - Country:US
Practice Address - Phone:480-947-3533
Practice Address - Fax:480-947-3531
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22649208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5867749OtherAETNA
AZAZ0710320OtherBLUE CROSSBLUE SHIELD
AZ1Z5739OtherHEALTHNET
AZAZ0710320OtherBLUE CROSSBLUE SHIELD
AZZ83962Medicare PIN