Provider Demographics
NPI:1891749081
Name:RASSOULI, MAJID (DO)
Entity type:Individual
Prefix:DR
First Name:MAJID
Middle Name:
Last Name:RASSOULI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:963 N 129TH INFANTRY DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3103
Mailing Address - Country:US
Mailing Address - Phone:815-729-3777
Mailing Address - Fax:815-725-9358
Practice Address - Street 1:963 N 129TH INFANTRY DR
Practice Address - Street 2:SUITE 110
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-3103
Practice Address - Country:US
Practice Address - Phone:815-729-3777
Practice Address - Fax:815-725-9358
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036106380207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCG9902OtherRETIRED RAILROAD MEDICARE
IL0009919581OtherBLUE CROSS BLUE SHIELD IL
IL180046167OtherRETIRED RAILROAD MEDICARE
IL036106380Medicaid
IL180046167-GRP CG9902OtherRR MEDICARE
IL0857370002Medicare NSC
ILK18042Medicare PIN
ILH76064Medicare UPIN
IL1780710780Medicare NSC
IL0009919581OtherBLUE CROSS BLUE SHIELD IL
IL036106380Medicaid
IL1619205077Medicare NSC
ILK18041Medicare PIN