Provider Demographics
NPI:1871529271
Name:KASSEES, LAILA ISSA (MD)
Entity type:Individual
Prefix:DR
First Name:LAILA
Middle Name:ISSA
Last Name:KASSEES
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 1:1129 HALE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-6373
Mailing Address - Country:US
Mailing Address - Phone:901-396-0390
Mailing Address - Fax:
Practice Address - Street 1:6385 STAGE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-3738
Practice Address - Country:US
Practice Address - Phone:901-386-1683
Practice Address - Fax:901-385-8252
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000008001208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3727579Medicaid
TN3838550Medicare ID - Type Unspecified
TN3727579Medicaid