Individual
BASSEM ATASSI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
206 E 86TH PL, MERRILLVILLE, IN 46410-6258
(219) 738-2722
(219) 736-7820
Mailing address
3707 DOTY ROAD, CREDENTIALING - SUITE F, WOODSTOCK, IL 60098
(815) 206-1068
(815) 337-5499
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
01026618A
IN
208800000X
Urology Physician
Primary
036047780
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000095415
BLUE CROSS
IN
01
—
0091108086
BLUE CROSS
IL
01
—
036047780
STATE LICENSE
IL
05
—
100168350A
—
IN
01
—
341664075
RAILROAD MEDICARE
IN
Enumeration date
11/28/2005
Last updated
03/17/2018
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