Provider Demographics
NPI:1740264688
Name:SADIK, ELIE (MD)
Entity type:Individual
Prefix:
First Name:ELIE
Middle Name:
Last Name:SADIK
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 1:206 MONTAGUE AVE
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723
Mailing Address - Country:US
Mailing Address - Phone:989-673-2102
Mailing Address - Fax:989-673-1591
Practice Address - Street 1:206 MONTAGUE AVE
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723
Practice Address - Country:US
Practice Address - Phone:989-673-2102
Practice Address - Fax:989-673-1591
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI052630207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1903919Medicaid
MI1903919Medicaid
E31411Medicare UPIN