Healthcare Provider Details

I. General information

NPI: 1154512242
Provider Name (Legal Business Name): AHMAD M ATASSI M. D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HIGHLAND AVE E3/311
MADISON WI
53792-3252
US

IV. Provider business mailing address

600 HIGHLAND AVE E3/311
MADISON WI
53792-3252
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-7500
  • Fax:
Mailing address:
  • Phone: 305-585-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number51860-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number51860-20
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number51860-20
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number51860-20
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number51860-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: