Provider Demographics
NPI:1508009457
Name:FLORIDA INTERNAL MEDICINE GROUP
Entity Type:Organization
Organization Name:FLORIDA INTERNAL MEDICINE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-872-0332
Mailing Address - Street 1:PO BOX 922
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32402-0922
Mailing Address - Country:US
Mailing Address - Phone:850-872-0332
Mailing Address - Fax:
Practice Address - Street 1:29 DOCTORS DRIVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405
Practice Address - Country:US
Practice Address - Phone:850-872-0332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91546174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty