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NPI Code Detail

MEDICARE: DR. ISAAC JOSHUA FAIBISOFF MD

MEDICARE: DR. ISAAC JOSHUA FAIBISOFF MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084N0400XNeurology Physician036-105092IL

General Provider Information

NPI Number : 1134114887
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ISAAC JOSHUA FAIBISOFF MD
Provider Business Mailing Address
First Line : 40 SYCAMORE DR
Second Line :
City : CASEYVILLE
State : IL
Zip : 62232-2048
Country : US
Telephone Number : 618-799-0861
Fax Number :
Provider Business Practice Location Address
First Line : 915 N GRAND BLVD
Second Line : A632
City : SAINT LOUIS
State : MO
Zip : 63106-1621
Country : US
Telephone Number : 314-289-4706
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2005
Last Update Date : 03/12/2025

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