MEDICARE: LORETTA R ISADA 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
1	207RC0000X	Cardiovascular Disease Physician	35-057341	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1841239274	OTHER	OH	MEDICARE GROUP NPI #
4	9338635	OTHER	OH	MEDICARE GROUP NUMBER

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265412944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORETTA R ISADA MD

Provider Business Mailing Address
First Line	:	4125 MEDINA RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44333-2483
Country	:	US
Telephone Number	:	330-665-8222
Fax Number	:	330-666-2599

Provider Business Practice Location Address
First Line	:	4125 MEDINA RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44333-2483
Country	:	US
Telephone Number	:	330-665-8222
Fax Number	:	330-666-2599

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	09/09/2010

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Directions to “ LORETTA R ISADA MD” Practice Location

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