Provider Demographics
NPI:1871533927
Name:ATASSI, WASSIM
Entity type:Individual
Prefix:DR
First Name:WASSIM
Middle Name:
Last Name:ATASSI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9696 GORDON DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-2909
Mailing Address - Country:US
Mailing Address - Phone:219-937-2511
Mailing Address - Fax:219-937-2522
Practice Address - Street 1:9696 GORDON DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2909
Practice Address - Country:US
Practice Address - Phone:219-937-2511
Practice Address - Fax:219-937-2522
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058603A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200084270AMedicaid
I06689Medicare UPIN
IN133710DMedicare ID - Type Unspecified