Individual
ESSAM Y. TELLAWI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
205 N EAST AVE, JACKSON, MI 49201-1753
(517) 205-4800
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301055821
MI
207RG0100X
Gastroenterology Physician
0101040870
VA
207RG0100X
Gastroenterology Physician
Primary
4301055821
MI
207RG0100X
Gastroenterology Physician
D34274
MD
207RG0100X
Gastroenterology Physician
MD-45632
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
026092800
MEDICAL ASSISTANCE
DC
01
—
04834
AMERIGROUP
—
01
—
107596
CIGNA
—
01
—
1093715690
MEDICAID
VA
01
—
110032815
RAILROAD MEDICARE
GA
01
—
218537
M.D. IPA
—
01
—
219846
BLUESHEILD
VA
01
—
248N273G
MEDICARE
MD
01
—
2980177
EVERCARE
—
01
—
318537
ALLIANCE
—
01
—
4115912
AETNA
—
01
—
477271700
MEDICAL ASSISTANCE
MD
01
—
54284801
CAREFIRST
MD
01
—
A618 0001
CAREFIRST
DC
01
—
G02093S01
MEDICARE
DC
Enumeration date
07/26/2005
Last updated
10/15/2025
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