Provider Demographics
NPI:1235102765
Name:BESCAK, GEORGE MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MICHAEL
Last Name:BESCAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3600 KOLBE RD
Mailing Address - Street 2:SUITE 013
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-1654
Mailing Address - Country:US
Mailing Address - Phone:440-282-5701
Mailing Address - Fax:440-282-7443
Practice Address - Street 1:3600 KOLBE RD
Practice Address - Street 2:SUITE 013
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1654
Practice Address - Country:US
Practice Address - Phone:440-282-5701
Practice Address - Fax:440-282-7443
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002683B207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0443596Medicaid
OHBE0485331Medicare PIN
OH0443596Medicaid