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General NPI Number Information
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NPI Number | 1093259228
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Entity Type | Individual
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Provider Name | ROBERT SOLOMON ISSAC NP-C
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Gender | Male
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Dates
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Enumeration Date | 12/07/2016
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 44200 WOODWARD AVE STE 112
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City | PONTIAC
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State | MI
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Zip | 48341-5046
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Country | US
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Telephone | 248-384-8100
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Fax | 248-384-8101
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Provider Business Mailing Address
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Address Line | 5701 BOW POINTE DR STE 100
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City | CLARKSTON
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State | MI
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Zip | 48346-3199
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Country | US
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Telephone | 248-625-2621
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Fax | 248-625-2622
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704272827
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License Number State | MI
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