Provider Demographics
NPI:1457813420
Name:ESSE, IDIRIS ABDIRAHMAN (MD)
Entity Type:Individual
Prefix:
First Name:IDIRIS
Middle Name:ABDIRAHMAN
Last Name:ESSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:IDIRIS
Other - Middle Name:I
Other - Last Name:MOHAMED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1818 N MEADE ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-3454
Mailing Address - Country:US
Mailing Address - Phone:920-731-4101
Mailing Address - Fax:920-735-7618
Practice Address - Street 1:1818 N MEADE ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-3454
Practice Address - Country:US
Practice Address - Phone:920-731-4101
Practice Address - Fax:920-735-7618
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI76850208M00000X, 207R00000X
MN71804207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine