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General NPI Number Information
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NPI Number | 1164240644
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Entity Type | Individual
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Provider Name | MR. KEVIN WASHINGTON ISAACS SR.
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Gender | Male
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Dates
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Enumeration Date | 10/02/2024
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 601 POYDRAS ST STE 102
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City | NEW ORLEANS
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State | LA
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Zip | 70130-6015
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Country | US
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Telephone | 954-812-5867
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Fax |
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Provider Business Mailing Address
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Address Line | 9300 CONROY WINDERMERE RD UNIT 1165
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City | WINDERMERE
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State | FL
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Zip | 34786-5047
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Country | US
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Telephone | 954-812-5867
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Fax |
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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