Provider Demographics
NPI:1295918597
Name:KASSOUF, AMY HEHR (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:HEHR
Last Name:KASSOUF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 S GREEN RD
Mailing Address - Street 2:SUITE 146
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-4128
Mailing Address - Country:US
Mailing Address - Phone:216-382-3806
Mailing Address - Fax:216-382-6735
Practice Address - Street 1:1611 S GREEN RD
Practice Address - Street 2:SUITE 146
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-4128
Practice Address - Country:US
Practice Address - Phone:216-382-3806
Practice Address - Fax:216-382-6735
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35065826207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2070735Medicaid
OH1154487932OtherGROUP NPI
OH9186053OtherGROUP MEDICARE LEGACY NUM
OH9186057OtherGROUP MEDICARE LEGACY NUM
OH9186052OtherMEDICARE GROUP LEGACY NUM
OH9186055OtherMEDICARE GROUP LEGACY NUM
OH1154487932OtherGROUP NPI
OHF74079Medicare UPIN
OH9186052OtherMEDICARE GROUP LEGACY NUM
OH9186055OtherMEDICARE GROUP LEGACY NUM
OH0755339Medicare PIN