Provider Demographics
NPI:1053313346
Name:ISSA, MARK G (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:G
Last Name:ISSA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 N MCCORD RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1753
Mailing Address - Country:US
Mailing Address - Phone:419-842-3000
Mailing Address - Fax:419-842-3042
Practice Address - Street 1:2940 N MCCORD RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1753
Practice Address - Country:US
Practice Address - Phone:419-842-3000
Practice Address - Fax:419-842-3042
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006858I207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2089734Medicaid
P00711886OtherRRMC
OH0863336Medicare PIN
OH0863331Medicare PIN
OH2089734Medicaid
OH4042892Medicare PIN
OH4134513Medicare PIN
P00711886OtherRRMC
OH0863338Medicare PIN
OH4134511Medicare PIN
OH0863337Medicare PIN
OH0863339Medicare PIN
OH0863334Medicare PIN
OH0863333Medicare PIN
OH060053585Medicare PIN