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General NPI Number Information
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NPI Number | 1730452285
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Entity Type | Organization
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Legal Business Name | WADAH ATASSI MD SC
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Dates
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Enumeration Date | 02/14/2012
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Last Update Date | 10/21/2016
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Provider Practice Location Address
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Address Line | 8632 S PULASKI RD
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City | CHICAGO
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State | IL
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Zip | 60652-3633
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Country | US
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Telephone | 312-965-4466
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Fax | 312-896-5658
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Provider Business Mailing Address
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Address Line | 907 SAINT STEPHENS GRN
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City | OAK BROOK
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State | IL
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Zip | 60523-2569
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Country | US
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Telephone | 312-965-4466
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Fax | 312-896-5658
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. WADAH ATASSI
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Credential | M.D.
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Telephone | 312-970-9758
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 036-081178
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License Number State | IL
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