| Samir K Kassicieh, DO, PC | |
|
1010 Bridge Blvd Sw Suite A Albuquerque NM 87105-3765 | |
| (505) 877-0212 | |
| (505) 877-0139 |
| Full Name | Samir K Kassicieh, DO, PC |
|---|---|
| Speciality | Family Medicine |
| Location | 1010 Bridge Blvd Sw, Albuquerque, New Mexico |
| Authorized Official Name and Position | Samir K Kassicieh (OWNER) |
| Authorized Official Contact | 5058770212 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Samir K Kassicieh, DO, PC Po Box 12435 Albuquerque NM 87195-0435 Ph: (505) 877-0212 | Samir K Kassicieh, DO, PC 1010 Bridge Blvd Sw Suite A Albuquerque NM 87105-3765 Ph: (505) 877-0212 |
| NPI Number | 1649430802 |
|---|---|
| Provider Enumeration Date | 06/11/2008 |
| Last Update Date | 11/19/2008 |
| Medicare PECOS PAC ID | 4688732993 |
|---|---|
| Medicare Enrollment ID | O20081015000118 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649430802 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Samir K Kassicieh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730254350 PECOS PAC ID: 4789742099 Enrollment ID: I20081015000106 |
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