Basic Information
| Provider Information | |||||||||
| NPI: | 1417916867 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ATASSI | ||||||||
| FirstName: | MOHAMED | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 36100 EUCLID AVE | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | WILLOUGHBY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440944456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4409518360 | ||||||||
| FaxNumber: | 4409519408 | ||||||||
| Practice Location | |||||||||
| Address1: | 36100 EUCLID AVE | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | WILLOUGHBY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440944456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4409518360 | ||||||||
| FaxNumber: | 4409519408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2006 | ||||||||
| LastUpdateDate: | 07/10/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 35-037183 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 0259009 | 05 | OH | MEDICAID | 2597481 | 01 | OH | UNITED HEALTHCARE | OTHER | 264168 | 01 | OH | FEDERAL BLACK LUNG | OTHER | 4006955 | 01 | OH | AETNA | OTHER | 18958 | 01 | OH | QUALCHOICE | OTHER | 000000130202 | 01 | OH | ANTHEM | OTHER | 341313510A | 01 | OH | SUMMACARE | OTHER |