Provider Demographics
NPI:1518116680
Name:KASSIM, THASLIM AHAMED (MD)
Entity Type:Individual
Prefix:DR
First Name:THASLIM
Middle Name:AHAMED
Last Name:KASSIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11264 N 128TH PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-4470
Mailing Address - Country:US
Mailing Address - Phone:240-603-2177
Mailing Address - Fax:480-422-9154
Practice Address - Street 1:2157 E BASELINE RD STE 101
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1544
Practice Address - Country:US
Practice Address - Phone:240-603-2177
Practice Address - Fax:480-422-9154
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN58370207R00000X
WI2226207R00000X, 207RC0000X
ND13252207RC0000X
AZ63043207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1461135Medicaid