Provider Demographics
NPI:1922081207
Name:MASSIS, KAMAL (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMAL
Middle Name:
Last Name:MASSIS
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 1:2700 UNIVERSITY SQUARE DR
Mailing Address - Street 2:RADIOLOGY ASSOCIATES OF TAMPA
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-5513
Mailing Address - Country:US
Mailing Address - Phone:813-251-5822
Mailing Address - Fax:813-254-4597
Practice Address - Street 1:2700 UNIVERSITY SQUARE DR
Practice Address - Street 2:RADIOLOGY ASSOCIATES OF TAMPA
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5513
Practice Address - Country:US
Practice Address - Phone:813-251-5822
Practice Address - Fax:813-254-4597
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME888372085R0202X
FLME 888372085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280434400Medicaid
AL118690Medicaid
FL37848SMedicare PIN
FL280434400Medicaid
FLP00627758Medicare PIN
FLP00636731Medicare PIN
FL37848WMedicare PIN
FL37848RMedicare PIN
FL37848UMedicare PIN