Provider Demographics
NPI:1023266533
Name:KASSAWAT, MUHANNAD (MD)
Entity type:Individual
Prefix:DR
First Name:MUHANNAD
Middle Name:
Last Name:KASSAWAT
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 1:11369 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:44452-9782
Mailing Address - Country:US
Mailing Address - Phone:330-965-9999
Mailing Address - Fax:234-759-3971
Practice Address - Street 1:11369 MARKET ST
Practice Address - Street 2:
Practice Address - City:NORTH LIMA
Practice Address - State:OH
Practice Address - Zip Code:44452-9782
Practice Address - Country:US
Practice Address - Phone:330-965-9999
Practice Address - Fax:234-759-3971
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43015059232084P0800X
TXS23642084P0802X
FLME1052242084P0802X
OH35.0922112084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00317310Medicaid
OH2903086Medicaid