MEDICARE: DR. ELSI MARIA BACCARI D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	5101009526	MI
2	207Q00000X	Family Medicine Physician	18403	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5170118	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1699827303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELSI MARIA BACCARI D.O.

Provider Business Mailing Address
First Line	:	2861 ORCHARD PLACE
Second Line	:
City	:	ORCHARD LAKE
State	:	MI
Zip	:	48324
Country	:	US
Telephone Number	:	313-378-9914
Fax Number	:	906-387-2825

Provider Business Practice Location Address
First Line	:	2861 ORCHARD PLACE
Second Line	:
City	:	ORCHARD LAKE
State	:	MI
Zip	:	48324
Country	:	US
Telephone Number	:	313-378-9914
Fax Number	:	906-387-2825

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/21/2023

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