Provider Demographics
NPI:1053405779
Name:ESCH, BRIAN K (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:K
Last Name:ESCH
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 1:218 W. WASHINGTON ST.,
Mailing Address - Street 2:SUITE 430
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601
Mailing Address - Country:US
Mailing Address - Phone:574-282-1060
Mailing Address - Fax:866-354-6402
Practice Address - Street 1:218 W. WASHINGTON ST.,
Practice Address - Street 2:SUITE 430
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601
Practice Address - Country:US
Practice Address - Phone:574-282-1060
Practice Address - Fax:866-354-6402
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010569842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
INF38579Medicare UPIN
IN224710Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER