Individual
ELIAS HABIB KASSAB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5250 AUTO CLUB DR STE 300, DEARBORN, MI 48126-2619
(313) 724-9000
(313) 562-9300
Mailing address
5250 AUTO CLUB DR STE 300, DEARBORN, MI 48126-2619
(313) 724-9000
(313) 562-9300
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301047006
MI
207RC0000X
Cardiovascular Disease Physician
Primary
4301047006
MI
207RI0011X
Interventional Cardiology Physician
4301047006
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060007968
MEDICARE RR
MI
01
—
0Q26305002
BLUECROSSBLUESHIELD OF MI
MI
05
—
1910717
—
MI
01
—
P51229
BLUECARE NETWORK
MI
Enumeration date
03/08/2006
Last updated
05/28/2019
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