MEDICARE: BRADLEY LEMAR ISAAK 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
1	207W00000X	Ophthalmology Physician	22566	IA

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	:	1699883256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY LEMAR ISAAK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1877
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50402-1877
Country	:	US
Telephone Number	:	641-423-8861
Fax Number	:	641-423-0727

Provider Business Practice Location Address
First Line	:	3121 4TH ST SW
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50401-1581
Country	:	US
Telephone Number	:	641-423-8861
Fax Number	:	641-423-0727

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	07/08/2007

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