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General NPI Number Information
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NPI Number | 1881899276
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Entity Type | Individual
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Provider Name | PRASANNA ISAAC M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 7836 W JEFFERSON BLVD STE 101
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City | FORT WAYNE
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State | IN
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Zip | 46804-4178
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Country | US
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Telephone | 260-494-3484
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Fax | 260-471-5507
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Provider Business Mailing Address
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Address Line | 120 W 22ND ST
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City | OAK BROOK
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State | IL
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Zip | 60523-1557
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Country | US
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Telephone | 630-573-5000
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 35.095468
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 01067936A
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License Number State | IN
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