1891749081 NPI number — DR. MAJID RASSOULI DO

Table of content: DR. MAJID RASSOULI DO (NPI 1891749081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891749081 NPI number — DR. MAJID RASSOULI DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RASSOULI
Provider First Name:
MAJID
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891749081
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
963 N 129TH INFANTRY DR
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
JOLIET
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60435-3103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-729-3777
Provider Business Mailing Address Fax Number:
815-725-9358

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
963 N 129TH INFANTRY DR
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
JOLIET
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60435-3103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-729-3777
Provider Business Practice Location Address Fax Number:
815-725-9358
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  036106380 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CG9902 . This is a "RETIRED RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0009919581 . This is a "BLUE CROSS BLUE SHIELD IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 180046167 . This is a "RETIRED RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036106380 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180046167-GRP CG9902 . This is a "RR MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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