MEDICARE: DR. KEITH ATASSI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	01038771A	IN
2	207RI0011X	Interventional Cardiology Physician	01038771A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	060034739	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000183526	OTHER	BLUE CROSS BLUE SHIELD IN
4	90000561	OTHER	BLUE SHIELD OF IL

General Provider Information

NPI Number	:	1336160753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH ATASSI M.D.

Provider Business Mailing Address
First Line	:	3800 SAINT MARY RD STE 202
Second Line	:
City	:	VALPARAISO
State	:	IN
Zip	:	46383-3986
Country	:	US
Telephone Number	:	219-286-3788
Fax Number	:	219-286-3791

Provider Business Practice Location Address
First Line	:	3800 SAINT MARY RD STE 202
Second Line	:
City	:	VALPARAISO
State	:	IN
Zip	:	46383-3986
Country	:	US
Telephone Number	:	219-286-3788
Fax Number	:	219-286-3791

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	09/30/2020

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Directions to “ DR. KEITH ATASSI M.D.” Practice Location

Language	Start Address	Practice Location

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