Provider Demographics
NPI:1730445743
Name:BASSIL, NADIJDA TANNOUS (MD)
Entity type:Individual
Prefix:
First Name:NADIJDA
Middle Name:TANNOUS
Last Name:BASSIL
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 1:1255 S MICHIGAN AVE APT 2505
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6918 GUNN HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-3853
Practice Address - Country:US
Practice Address - Phone:813-891-6310
Practice Address - Fax:813-891-6889
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036144058207Q00000X
FLME124206207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine