Healthcare Provider Details

I. General information

NPI: 1073508172
Provider Name (Legal Business Name): MOHAMAD FATIN ATASSI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6625 S PULASKI RD
CHICAGO IL
60629-5137
US

IV. Provider business mailing address

6625 S PULASKI RD
CHICAGO IL
60629-5137
US

V. Phone/Fax

Practice location:
  • Phone: 773-585-1555
  • Fax: 773-585-1787
Mailing address:
  • Phone: 773-585-1555
  • Fax: 773-585-1787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036062020
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: