Provider Demographics
NPI:1467532002
Name:BASSEM ADIE MD PLLC
Entity Type:Organization
Organization Name:BASSEM ADIE MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRIMARY PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BASSEM
Authorized Official - Middle Name:
Authorized Official - Last Name:ADIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-723-0122
Mailing Address - Street 1:133 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:KY
Mailing Address - Zip Code:40336-1084
Mailing Address - Country:US
Mailing Address - Phone:606-723-0122
Mailing Address - Fax:
Practice Address - Street 1:133 MAIN ST
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-1084
Practice Address - Country:US
Practice Address - Phone:606-723-0122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33306207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000046044OtherBLUE CROSS
KY64001738Medicaid
KYG62653Medicare UPIN
KY64001738Medicaid