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General NPI Number Information
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NPI Number | 1659361335
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Entity Type | Individual
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Provider Name | DAVID J ISAACSON MD
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Gender | Male
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Dates
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Enumeration Date | 10/25/2005
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Last Update Date | 03/31/2021
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Provider Practice Location Address
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Address Line | 100 NAVARRE PL STE 4460
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City | SOUTH BEND
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State | IN
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Zip | 46601-1168
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Country | US
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Telephone | 574-235-1010
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Fax | 574-232-2064
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Provider Business Mailing Address
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Address Line | 710 N NILES AVE
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City | SOUTH BEND
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State | IN
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Zip | 46617-1924
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Country | US
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Telephone | 574-647-1610
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Fax | 574-237-6069
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 01050253A
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License Number State | IN
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