Provider Demographics
NPI:1780948299
Name:BOURGI, KASSEM (MD)
Entity type:Individual
Prefix:
First Name:KASSEM
Middle Name:
Last Name:BOURGI
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 31609
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-0169
Mailing Address - Country:US
Mailing Address - Phone:615-499-7406
Mailing Address - Fax:833-968-2944
Practice Address - Street 1:442 METROPLEX DR STE 200
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-3112
Practice Address - Country:US
Practice Address - Phone:615-499-7406
Practice Address - Fax:833-968-2944
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN71966207RI0200X, 207R00000X
MI4301100453207R00000X
IN01080959A207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN264910199OtherMEDICARE PTAN
INQ00008371OtherRAILROAD PTAN
IN300017285Medicaid
IN068010534OtherMEDICARE PTAN