Provider Demographics
NPI:1073681037
Name:ELSABBAGH, ALEX (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:ELSABBAGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 N TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1622
Mailing Address - Country:US
Mailing Address - Phone:313-274-6666
Mailing Address - Fax:313-274-4466
Practice Address - Street 1:1000 N TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48128-1622
Practice Address - Country:US
Practice Address - Phone:313-274-6666
Practice Address - Fax:313-274-4466
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080518208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI17474OtherMCARE
MI3508206102OtherBCBS
MI0820610OtherBCN
MI12965OtherCAPE MEDICAL
MI6U4930OtherCIGNA
MI489769110Medicaid
MI12965OtherCAPE MEDICAL