Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 47391-20 | WI |
NPI | 1043262439 |
---|---|
Provider Name | Jason S Isenberg |
First Address | Madison, WI 53715-1911 |
Second Address | Madison, WI 53715-1911 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 25/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1043262439 | (05) | WI |