Provider Demographics
NPI:1174545628
Name:KASSIS, TAUFIK (MD)
Entity type:Individual
Prefix:DR
First Name:TAUFIK
Middle Name:
Last Name:KASSIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:FRENCHBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40322-8123
Mailing Address - Country:US
Mailing Address - Phone:606-768-9190
Mailing Address - Fax:606-768-9180
Practice Address - Street 1:784 HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:FRENCHBURG
Practice Address - State:KY
Practice Address - Zip Code:40322-8123
Practice Address - Country:US
Practice Address - Phone:606-768-9190
Practice Address - Fax:606-768-9180
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36974207RA0401X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64055361Medicaid
KY000000260152OtherANTHEM
KY35002021Medicaid
KY64055361Medicaid
KY50005470OtherPASSPORT
KY930126582OtherRR-MEDICARE
KY35002021Medicaid
KY0614747Medicare PIN
KY930126582OtherRR-MEDICARE
KY0737101Medicare PIN
KY50005470OtherPASSPORT
KY183949Medicare PIN
KYK096130Medicare PIN