Provider Demographics
NPI:1073562179
Name:ISAACSON, DAVID R (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:ISAACSON
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 1:1000 MINERAL POINT AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2940
Mailing Address - Country:US
Mailing Address - Phone:608-756-6261
Mailing Address - Fax:068-756-6236
Practice Address - Street 1:1000 MINERAL POINT AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2940
Practice Address - Country:US
Practice Address - Phone:608-756-6261
Practice Address - Fax:068-756-6236
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1907851207R00000X, 208M00000X
WI56921-20208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02356898Medicaid
WIISAACDAVOtherMERCYCARE INSURANCE
WI1073562179OtherBCBSWI
WIP01029450CG6042OtherRR MEDICARE
WI1073562179Medicaid
NY02356898Medicaid
WIISAACDAVOtherMERCYCARE INSURANCE
DD3363Medicare PIN
G05356Medicare UPIN
WI1073562179Medicaid
RA4687Medicare PIN