Provider Demographics
NPI:1194772954
Name:ASSI, NIZAR A (MD)
Entity type:Individual
Prefix:DR
First Name:NIZAR
Middle Name:A
Last Name:ASSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10012 KENNERLY RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2197
Mailing Address - Country:US
Mailing Address - Phone:313-729-0088
Mailing Address - Fax:314-729-3963
Practice Address - Street 1:10012 KENNERLY RD
Practice Address - Street 2:SUITE 301
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2197
Practice Address - Country:US
Practice Address - Phone:314-729-0088
Practice Address - Fax:314-729-3963
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2016-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR5N90207RC0000X
IL036076345207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036076345Medicaid
MO1017484OtherCARE PARTNERS
MO20848OtherBCBS
MO2411584004OtherCIGNA PAL REFERRAL
MO738934OtherFIRST HEALTH NETWORK
MO137842OtherHEALTHLINK
MO47082OtherGROUP HEALTH PLAN
MO951660OtherAETNA
MO203035324Medicaid
MO14443OtherESSENCE HEALTHCARE
MO19567OtherHEALTHCARE USA
MO21238OtherEXCLUSIVE CHOICE
MO2500139OtherUNITED HEALTH CARE
IL04232002OtherBCBS
MO2411584OtherCIGNA HMO PPO OPEN ACCESS
MOD88680OtherMERCY HEALTH PLAN
060032092Medicare PIN
IL04232002OtherBCBS
MO002012159Medicare ID - Type Unspecified
MO738934OtherFIRST HEALTH NETWORK
MO19567OtherHEALTHCARE USA