Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 07000414A | IN |
N | 222Z00000X | Podiatrist | 07000414A | IN |
N | 2081S0010X | Sports Medicine | 07000414A | IN |
N | 213ES0000X | Sports Medicine | 07000414A | IN |
Y | 213ES0103X | Foot & Ankle Surgery | 07000414A | IN |
NPI | 1154323590 |
---|---|
Provider Name | Richard Lee Isaacson |
First Address | Indianapolis, IN 46260-1931 |
Second Address | Indianapolis, IN 46260-1931 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 05/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100061710 A & B | (05) | IN |
T34525 | (02) | IN |