Provider Demographics
NPI:1447408836
Name:KASSIS, JEAN-JACQUES (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEAN-JACQUES
Middle Name:
Last Name:KASSIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18525 W DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2614
Mailing Address - Country:US
Mailing Address - Phone:305-935-0503
Mailing Address - Fax:305-359-9601
Practice Address - Street 1:18525 W DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33180-2614
Practice Address - Country:US
Practice Address - Phone:305-935-0503
Practice Address - Fax:305-359-9601
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01488213ES0103X
FLPO3410213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC189281YFCTMedicare PIN
FLHE392YMedicare PIN
MD213E123400000XMedicare PIN