Provider Demographics
NPI:1760755268
Name:PRIUS HEALTH MEDICAL GROUP SC
Entity Type:Organization
Organization Name:PRIUS HEALTH MEDICAL GROUP SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WADAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ATASSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-965-4466
Mailing Address - Street 1:907 SAINT STEPHENS GRN
Mailing Address - Street 2:WADAH ATASSI
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523
Mailing Address - Country:US
Mailing Address - Phone:312-965-4466
Mailing Address - Fax:312-896-5658
Practice Address - Street 1:3650 W ARMITAGE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647
Practice Address - Country:US
Practice Address - Phone:312-965-4466
Practice Address - Fax:312-896-5658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-081178261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center