Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 24765 | NE |
Y | 207Q00000X | Family Doctor | 38928 | IA |
NPI | 1003027939 |
---|---|
Provider Name | Dr. Todd Mikael Isaacson |
First Address | Shenandoah, IA 51601-2355 |
Second Address | Shenandoah, IA 51601-4586 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 14/10/2021 |