Provider Demographics
NPI:1073596706
Name:ATASSI, BASSEM (MD)
Entity Type:Individual
Prefix:
First Name:BASSEM
Middle Name:
Last Name:ATASSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3707 DOTY ROAD
Mailing Address - Street 2:CREDENTIALING - SUITE F
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098
Mailing Address - Country:US
Mailing Address - Phone:815-206-1068
Mailing Address - Fax:815-337-5499
Practice Address - Street 1:206 E 86TH PL
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6258
Practice Address - Country:US
Practice Address - Phone:219-738-2722
Practice Address - Fax:219-736-7820
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036047780208800000X
IN01026618A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100168350AMedicaid
IN341664075OtherRAILROAD MEDICARE
IN000000095415OtherBLUE CROSS
IL036047780OtherSTATE LICENSE
IL0091108086OtherBLUE CROSS