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NPI Code Detail

MEDICARE: ENRIQUE ISIDRO M.D.

MEDICARE: ENRIQUE ISIDRO M.D.
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
1208100000XPhysical Medicine & Rehabilitation Physician49617GA

Other Identifiers

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

General Provider Information

NPI Number : 1356399646
Entity Type Code : Individual
Provider Name (Legal Business Name) : ENRIQUE ISIDRO M.D.
Provider Business Mailing Address
First Line : 6391 ROOSEVELT HWY
Second Line :
City : WARM SPRINGS
State : GA
Zip : 31830-2281
Country : US
Telephone Number : 706-655-5302
Fax Number : 706-655-5303
Provider Business Practice Location Address
First Line : 6391 ROOSEVELT HWY
Second Line :
City : WARM SPRINGS
State : GA
Zip : 31830-2281
Country : US
Telephone Number : 706-655-5337
Fax Number : 706-655-5299
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2006
Last Update Date : 01/26/2010

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