Healthcare Provider Details

I. General information

NPI: 1407218621
Provider Name (Legal Business Name): HADI ATASSI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2016
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9030 COLUMBIA AVE STE B
MUNSTER IN
46321-2905
US

IV. Provider business mailing address

9030 COLUMBIA AVE STE B
MUNSTER IN
46321-2905
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-6002
  • Fax: 219-836-6003
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number02007039A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number04701
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: