Provider Demographics
NPI:1013114131
Name:EL BIZRI, ISSAM (MD)
Entity type:Individual
Prefix:
First Name:ISSAM
Middle Name:
Last Name:EL BIZRI
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 1:1414 W FAIR AVE STE 344
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-5407
Mailing Address - Country:US
Mailing Address - Phone:906-449-1300
Mailing Address - Fax:906-629-6482
Practice Address - Street 1:1414 W FAIR AVE STE 344
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-5407
Practice Address - Country:US
Practice Address - Phone:906-449-1300
Practice Address - Fax:906-629-6482
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018000535207R00000X
KS046827207R00000X
NH14705207R00000X
MI4301510857207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3079449Medicaid