Provider Demographics
NPI:1902952690
Name:QURAISHI, ESSAM R (MD)
Entity type:Individual
Prefix:DR
First Name:ESSAM
Middle Name:R
Last Name:QURAISHI
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 1:2621 S BRISTOL ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-5718
Mailing Address - Country:US
Mailing Address - Phone:657-900-4536
Mailing Address - Fax:657-208-9732
Practice Address - Street 1:2621 S BRISTOL ST STE 202
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5718
Practice Address - Country:US
Practice Address - Phone:657-900-4536
Practice Address - Fax:657-208-9732
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC133332207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3137000Medicaid
OH4309821Medicare PIN