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General NPI Number Information
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NPI Number | 1336242148
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Entity Type | Organization
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Legal Business Name | ERNEST V ISADORE DPM PC
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 1414 W ILLINOIS AVENUE
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City | AURORA
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State | IL
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Zip | 60506-1920
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Country | US
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Telephone | 630-895-1450
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Fax | 630-859-1466
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Provider Business Mailing Address
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Address Line | 1414 W ILLINOIS AVENUE
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City | AURORA
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State | IL
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Zip | 60506-1920
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Country | US
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Telephone | 630-895-1450
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Fax | 630-859-1466
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERNEST V. ISADORE
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Credential | DPM
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Telephone | 630-859-1450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016002699
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License Number State | IL
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