MEDICARE: DR. TAMARA ISAKOVA 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	207RN0300X	Nephrology Physician	107174	FL

General Provider Information

NPI Number	:	1902879778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAMARA ISAKOVA MD

Provider Business Mailing Address
First Line	:	633 N SAINT CLAIR ST
Second Line	:	18TH FLOOR ROOM 18-083
City	:	CHICAGO
State	:	IL
Zip	:	60611-3234
Country	:	US
Telephone Number	:	312-503-6921
Fax Number	:	312-503-5656

Provider Business Practice Location Address
First Line	:	633 N SAINT CLAIR ST
Second Line	:	18TH FLOOR ROOM 18-083
City	:	CHICAGO
State	:	IL
Zip	:	60611-3234
Country	:	US
Telephone Number	:	312-503-6921
Fax Number	:	312-503-5656

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

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	09/30/2013

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