Provider Demographics
NPI:1073508172
Name:ATASSI, MOHAMAD FATIN (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:FATIN
Last Name:ATASSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6625 S PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-5137
Mailing Address - Country:US
Mailing Address - Phone:773-585-1555
Mailing Address - Fax:773-585-1787
Practice Address - Street 1:6625 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-5137
Practice Address - Country:US
Practice Address - Phone:773-585-1555
Practice Address - Fax:773-585-1787
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062020207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036062020Medicaid
C47492Medicare UPIN