Healthcare Provider Details

I. General information

NPI: 1568808715
Provider Name (Legal Business Name): ISAAC SOMMER MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 LINCOLNWAY E
MISHAWAKA IN
46544-2016
US

IV. Provider business mailing address

113 LINCOLNWAY E
MISHAWAKA IN
46544-2016
US

V. Phone/Fax

Practice location:
  • Phone: 574-255-4976
  • Fax: 574-255-1882
Mailing address:
  • Phone: 574-255-4976
  • Fax: 574-255-1882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: