Provider Demographics
NPI:1023053808
Name:KASSEM, MOHAMMED AZHER (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:AZHER
Last Name:KASSEM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1500 S CALIFORNIA AV
Mailing Address - Street 2:MT SINAI HOSPITAL , CANCER CARE CENTER, 6TH FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-9025
Mailing Address - Country:US
Mailing Address - Phone:773-257-6120
Mailing Address - Fax:
Practice Address - Street 1:1501 S CALIFORNIA AVE
Practice Address - Street 2:MT SINAI HOSPITAL, CANCER CARE CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1732
Practice Address - Country:US
Practice Address - Phone:773-257-6120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-112270207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL134589Medicare UPIN