MEDICARE: RICHARD LEE ISAACSON D.P.M.

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
1	213E00000X	Podiatrist	07000414A	IN
2	213ES0103X	Foot & Ankle Surgery Podiatrist	07000414A	IN
3	213ES0000X	Sports Medicine Podiatrist	07000414A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154323590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD LEE ISAACSON D.P.M.

Provider Business Mailing Address
First Line	:	2020 W 86TH ST
Second Line	:	108
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1931
Country	:	US
Telephone Number	:	317-872-0984
Fax Number	:	317-872-0349

Provider Business Practice Location Address
First Line	:	2020 W 86TH ST
Second Line	:	108
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1931
Country	:	US
Telephone Number	:	317-872-0984
Fax Number	:	317-872-0349

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	04/05/2017

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Directions to “ RICHARD LEE ISAACSON D.P.M.” Practice Location

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