Individual
DR. SAMIR KASSICIEH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1010 BRIDGE BLVD SW STE 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
A751
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40279
—
NM
01
—
A751
NM STATE ID
—
Enumeration date
11/21/2006
Last updated
08/01/2008
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