Basic Information
| Provider Information | |||||||||
| NPI: | 1447677679 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GHASSIBI | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | CIRIL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11277 VERNON PL | ||||||||
| Address2: | STE 200 | ||||||||
| City: | MEADVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 163353719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147241252 | ||||||||
| FaxNumber: | 8143338871 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 VIRGINIA AVENUE | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652120001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738822663 | ||||||||
| FaxNumber: | 5738821760 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2014 | ||||||||
| LastUpdateDate: | 05/26/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 2019009763 | MO | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.