Healthcare Provider Details

I. General information

NPI: 1710969639
Provider Name (Legal Business Name): RACHEED M ATASSI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 N MAIN ST
ROMEO MI
48065-4619
US

IV. Provider business mailing address

PO BOX 37
ROMEO MI
48065-0037
US

V. Phone/Fax

Practice location:
  • Phone: 586-752-9694
  • Fax:
Mailing address:
  • Phone: 586-752-9694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301094667
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: