Provider Demographics
NPI:1548276819
Name:ATASSI, TAMER (MD)
Entity type:Individual
Prefix:DR
First Name:TAMER
Middle Name:
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 433
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439
Mailing Address - Country:US
Mailing Address - Phone:630-685-2877
Mailing Address - Fax:630-395-9796
Practice Address - Street 1:2121 ONEIDA ST
Practice Address - Street 2:SUITE 302
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6544
Practice Address - Country:US
Practice Address - Phone:630-685-2877
Practice Address - Fax:630-395-9796
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113533207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036113533Medicaid
K23283Medicare PIN
IL208535Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
IL036113533Medicaid