Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 1013411834 | IL |
NPI | 1013411834 |
---|---|
Provider Name | Dr. Dylan Samuel Isaacson |
First Address | Chicago, IL 60611-2205 |
Second Address | Chicago, IL 60611-3055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2018 |
Last Update Date | 14/05/2019 |