Healthcare Provider Details

I. General information

NPI: 1023081221
Provider Name (Legal Business Name): RAYMOND ISAKOV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE A60
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE A60
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-3765
  • Fax: 216-444-9419
Mailing address:
  • Phone: 216-445-3765
  • Fax: 216-444-9419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberM2660
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number35.084047
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: