Healthcare Provider Details

I. General information

NPI: 1144516873
Provider Name (Legal Business Name): ANDREW ROBERT ISAACSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SAINT ANTOINE ST 6C DEPARTMENT OF SURGERY-DMC
DETROIT MI
48201-2153
US

IV. Provider business mailing address

69 JESSE HILL JR. DRIVE 3RD FLOOR
ATLANTA GA
30303
US

V. Phone/Fax

Practice location:
  • Phone: 313-577-5009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301098419
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number0708045
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number4301117409
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: