Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 52829 | MN |
NPI | 1073788519 |
---|---|
Provider Name | Isaac Thomas Marsolek |
First Address | St Paul, MN 55130-5302 |
Second Address | St Paul, MN 55130-5302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2008 |
Last Update Date | 14/12/2016 |