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General NPI Number Information
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NPI Number | 1093715690
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Entity Type | Individual
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Provider Name | ESSAM Y. TELLAWI M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/26/2005
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 205 N EAST AVE
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City | JACKSON
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State | MI
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Zip | 49201-1753
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Country | US
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Telephone | 517-205-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 1 FORD PL STE 3A
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City | DETROIT
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State | MI
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Zip | 48202-3450
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 4301055821
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 0101040870
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301055821
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MD-45632
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License Number State | IA
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Taxonomy #5
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | D34274
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License Number State | MD
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