MEDICARE: THOMAS C ISAACSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	4664	SD
2	207RI0011X	Interventional Cardiology Physician	19546	NV
3	207RI0011X	Interventional Cardiology Physician	4664	SD
4	207RI0011X	Interventional Cardiology Physician	32847	WI
5	207RC0000X	Cardiovascular Disease Physician	32847	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	103715	OTHER		UCARE
2	51B19IS	OTHER	MN	MN BCBS
3	538R81IS	OTHER	MN	MN BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	931451029037	OTHER		PREFERRED ONE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	0006848	OTHER	SD	SD BCBS
8	25-00471	OTHER		SELECTCARE
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	25118	OTHER	IA	IA BCBS
11	35614	OTHER		HEALTH PARTNERS

General Provider Information

NPI Number	:	1104884311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS C ISAACSON MD

Provider Business Mailing Address
First Line	:	PO BOX 98978
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89193-8978
Country	:	US
Telephone Number	:	702-216-3346
Fax Number	:

Provider Business Practice Location Address
First Line	:	10105 BANBURRY CROSS DR STE 250
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-6648
Country	:	US
Telephone Number	:	702-360-7600
Fax Number	:	702-363-3814

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	09/07/2021

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Directions to “ THOMAS C ISAACSON MD” Practice Location

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