Provider Demographics
NPI:1528027356
Name:KASSEM, MOHAMED (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:
Last Name:KASSEM
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: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:850-769-7717
Practice Address - Street 1:210 FOREST PARK CIR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4915
Practice Address - Country:US
Practice Address - Phone:850-872-0332
Practice Address - Fax:850-769-7717
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91546207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271651800Medicaid
FL52193OtherBCBS FLORIDA
FL6989950001Medicare NSC
FL52193OtherBCBS FLORIDA
FLME91546Medicare UPIN