Provider Demographics
NPI:1477627875
Name:KASSIS, ANTOINE (MD)
Entity Type:Individual
Prefix:MR
First Name:ANTOINE
Middle Name:
Last Name:KASSIS
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 1:504 BASSWOOD CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4436
Mailing Address - Country:US
Mailing Address - Phone:904-256-3330
Mailing Address - Fax:904-256-3332
Practice Address - Street 1:2449 UNIVERSITY BLVD W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2037
Practice Address - Country:US
Practice Address - Phone:904-256-3330
Practice Address - Fax:904-256-3332
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75962207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263567400Medicaid
FL11161Medicare ID - Type Unspecified
FL263567400Medicaid