Provider Demographics
NPI:1235102765
Name:BESCAK, GEORGE MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MICHAEL
Last Name:BESCAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 COOPER FOSTER PARK RD STE 1
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-1002
Mailing Address - Country:US
Mailing Address - Phone:440-282-5701
Mailing Address - Fax:440-282-7443
Practice Address - Street 1:100 COOPER FOSTER PARK RD STE 1
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-1002
Practice Address - Country:US
Practice Address - Phone:440-282-5701
Practice Address - Fax:440-282-7443
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002683207R00000X, 207RN0300X
OH34002683B207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0443596Medicaid
OHBE0485331Medicare PIN
OH0443596Medicaid