Provider Demographics
NPI:1588623508
Name:EL-ATASSI, RAFEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFEL
Middle Name:
Last Name:EL-ATASSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAFEL
Other - Middle Name:
Other - Last Name:ATASSI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 40058
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-0058
Mailing Address - Country:US
Mailing Address - Phone:440-333-1101
Mailing Address - Fax:440-333-1130
Practice Address - Street 1:20220 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3501
Practice Address - Country:US
Practice Address - Phone:440-333-1101
Practice Address - Fax:440-333-1130
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35055665174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0942476Medicaid
OH0942476Medicaid
OHF65781Medicare UPIN