Individual
ESSAM A. MONTASIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
236 SIMPSON AVE, ELKHART, IN 46516-4666
(574) 293-0052
(574) 293-1739
Mailing address
236 SIMPSON AVE, ELKHART, IN 46516-4666
(574) 293-0052
(574) 293-1739
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
063440
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
308046210
—
MI
01
—
700H262220
BLUE CROSS-BLUE CROSS
—
01
—
MM063440
COMMERCIAL-COMMERCIAL NUMBER
—
Enumeration date
12/01/2006
Last updated
10/04/2023
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