Provider Demographics
NPI:1073788519
Name:MARSOLEK, ISAAC THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:THOMAS
Last Name:MARSOLEK
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 1:401 PHALEN BLVED
Mailing Address - Street 2:
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55130-5302
Mailing Address - Country:US
Mailing Address - Phone:651-254-5776
Mailing Address - Fax:651-254-7765
Practice Address - Street 1:401 PHALEN BLVED
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-5302
Practice Address - Country:US
Practice Address - Phone:651-254-5776
Practice Address - Fax:651-254-7765
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN528292081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine