Organization
SAMIR K KASSICIEH, DO, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMIR K KASSICIEH D. O. (OWNER)
(505) 877-0212
Entity
Organization
Contact information
Practice address
1010 BRIDGE BLVD SW, SUITE A, ALBUQUERQUE, NM 87105-3765
(505) 877-0212
(505) 877-0139
Mailing address
PO BOX 12435, ALBUQUERQUE, NM 87195-0435
(505) 877-0212
(505) 877-0139
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40279
—
NM
Enumeration date
06/11/2008
Last updated
11/19/2008
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