Basic Information
Provider Information | |||||||||
NPI: | 1154512242 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ATASSI | ||||||||
FirstName: | AHMAD | ||||||||
MiddleName: | M | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M. D | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 600 HIGHLAND AVE | ||||||||
Address2: | E3/311 | ||||||||
City: | MADISON | ||||||||
State: | WI | ||||||||
PostalCode: | 537923252 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3055857500 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 600 HIGHLAND AVE | ||||||||
Address2: | E3/311 | ||||||||
City: | MADISON | ||||||||
State: | WI | ||||||||
PostalCode: | 537923252 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3055857500 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/05/2007 | ||||||||
LastUpdateDate: | 12/08/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0700X | 51860-20 | WI | Y |   | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085R0202X | 51860-20 | WI | N |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | 51860-20 | WI | N |   | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085B0100X | 51860-20 | WI | N |   | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085D0003X | 51860-20 | WI | N |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Neuroimaging |
No ID Information.