Provider Demographics
NPI:1407089923
Name:BASSUK, ANGEL (MD)
Entity Type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:
Last Name:BASSUK
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 1:90 KELLEYS TRL
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-1976
Mailing Address - Country:US
Mailing Address - Phone:727-460-4353
Mailing Address - Fax:
Practice Address - Street 1:9655 WOODS DR
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-4418
Practice Address - Country:US
Practice Address - Phone:727-460-4353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0510922086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery