Provider Demographics
NPI:1063508083
Name:PIKE, ISADORE M (MD)
Entity Type:Individual
Prefix:DR
First Name:ISADORE
Middle Name:M
Last Name:PIKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-2521
Mailing Address - Country:US
Mailing Address - Phone:251-990-3098
Mailing Address - Fax:251-990-3417
Practice Address - Street 1:105 N SUMMIT ST
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2521
Practice Address - Country:US
Practice Address - Phone:251-990-3098
Practice Address - Fax:251-990-3417
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00025872207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C 85992Medicare UPIN