Individual
SOPHIA KASSEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
495 E MAIN ST, COLUMBUS, OH 43215-5349
(614) 355-8007
(614) 355-8620
Mailing address
DEPT 781625, DETROIT, MI 48278-1625
(614) 355-8004
(614) 355-2220
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
34010367
OH
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
34.010367
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2846675
—
OH
Enumeration date
10/21/2008
Last updated
02/02/2015
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