Provider Demographics
NPI:1710969639
Name:ATASSI, RACHEED M (MD)
Entity Type:Individual
Prefix:
First Name:RACHEED
Middle Name:M
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:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:ROMEO
Mailing Address - State:MI
Mailing Address - Zip Code:48065-0037
Mailing Address - Country:US
Mailing Address - Phone:586-752-9694
Mailing Address - Fax:
Practice Address - Street 1:241 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROMEO
Practice Address - State:MI
Practice Address - Zip Code:48065-4619
Practice Address - Country:US
Practice Address - Phone:586-752-9694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301094667207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1105004461OtherBCBSM
MI1457583692OtherMEDICAID GROUP ID
AL529908510Medicaid
51523499OtherBC/BS - SYLACAUGA
AL540003928Medicaid
MI1710969639Medicaid
AL009975195Medicaid
51523326OtherBC/BS - GOODWATER
AL543928003Medicaid
051554884Medicare ID - Type Unspecified
AL540003928Medicaid
MIMI2100Medicare PIN