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General NPI Number Information
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NPI Number | 1194452508
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Entity Type | Individual
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Provider Name | MARINA ISAC DPM
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Gender | Female
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Dates
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Enumeration Date | 08/05/2022
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 2805 N HURSTBOURNE PKWY STE 105
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City | LOUISVILLE
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State | KY
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Zip | 40223-1285
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Country | US
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Telephone | 502-447-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 2222 W DIVISION ST
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City | CHICAGO
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State | IL
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Zip | 60622-2717
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Country | US
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Telephone | 773-862-3600
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 297741
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License Number State | KY
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