Healthcare Provider Details

I. General information

NPI: 1285837138
Provider Name (Legal Business Name): B. ATASSI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 10/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 E 86TH PL
MERRILLVILLE IN
46410-6258
US

IV. Provider business mailing address

206 E 86TH PL
MERRILLVILLE IN
46410-6258
US

V. Phone/Fax

Practice location:
  • Phone: 219-738-2722
  • Fax:
Mailing address:
  • Phone: 219-738-2722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number01026618
License Number StateIN

VIII. Authorized Official

Name: DR. BASSEM ATASSI
Title or Position: MD
Credential: MD
Phone: 219-738-2722