Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 01064684A | IN |
NPI | 1063691830 |
---|---|
Provider Name | Mohamad Kassar |
First Address | Dyer, IN 46311-1596 |
Second Address | Dyer, IN 46311-1596 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2007 |
Last Update Date | 22/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200448210 | (05) | IN |
I08416 | (02) |