Provider Demographics
NPI:1174613889
Name:ADIE, BASSEM (MD)
Entity type:Individual
Prefix:DR
First Name:BASSEM
Middle Name:
Last Name:ADIE
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 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:844-630-0700
Mailing Address - Fax:877-374-1924
Practice Address - Street 1:305 NEW ALBANY PLZ
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4653
Practice Address - Country:US
Practice Address - Phone:812-668-8133
Practice Address - Fax:877-772-5818
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33306207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY10801935OtherCAQH PROVIDER ID
KY64001738OtherKMAP
KY000000046044OtherBC/BS
KY110188405OtherRAILROAD MEDICARE
KY3565OtherTRICARE
KY64001738Medicaid
KY64001738Medicaid
KY0582201Medicare ID - Type Unspecified