Provider Demographics
NPI:1437256518
Name:ESSAK, BAHA DAVID (MD)
Entity Type:Individual
Prefix:
First Name:BAHA
Middle Name:DAVID
Last Name:ESSAK
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 1:1500 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-1352
Mailing Address - Country:US
Mailing Address - Phone:810-245-3000
Mailing Address - Fax:810-245-3076
Practice Address - Street 1:1500 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1352
Practice Address - Country:US
Practice Address - Phone:810-245-3000
Practice Address - Fax:810-245-3076
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059235207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0804412391OtherBLUE CARE NETWORK
MI4614400Medicaid
MI0804412391OtherBLUE CROSS BLUE SHIELD
MI0N94200Medicare ID - Type Unspecified
MI4614400Medicaid