MEDICARE: MR. KEVIN WASHINGTON ISAACS SR.

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1164240644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN WASHINGTON ISAACS SR.

Provider Business Mailing Address
First Line	:	9300 CONROY WINDERMERE RD UNIT 1165
Second Line	:
City	:	WINDERMERE
State	:	FL
Zip	:	34786-5047
Country	:	US
Telephone Number	:	954-812-5867
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 POYDRAS ST STE 102
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70130-6015
Country	:	US
Telephone Number	:	954-812-5867
Fax Number	:

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

Provider Enumeration Date	:	10/02/2024
Last Update Date	:	10/02/2024

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