Provider Demographics
NPI:1699827303
Name:BACCARI, ELSI MARIA (DO)
Entity Type:Individual
Prefix:DR
First Name:ELSI
Middle Name:MARIA
Last Name:BACCARI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2861 ORCHARD PLACE
Mailing Address - Street 2:
Mailing Address - City:ORCHARD LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48324
Mailing Address - Country:US
Mailing Address - Phone:313-378-9914
Mailing Address - Fax:906-387-2825
Practice Address - Street 1:2861 ORCHARD PLACE
Practice Address - Street 2:
Practice Address - City:ORCHARD LAKE
Practice Address - State:MI
Practice Address - Zip Code:48324
Practice Address - Country:US
Practice Address - Phone:313-378-9914
Practice Address - Fax:906-387-2825
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009526207Q00000X
WI18403207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5170118OtherBLUE CROSS BLUE SHIELD
MIE37510Medicare UPIN
MI0P21840001Medicare ID - Type Unspecified