Provider Demographics
NPI:1134114887
Name:FAIBISOFF, ISAAC JOSHUA (MD)
Entity Type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:JOSHUA
Last Name:FAIBISOFF
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 1:27 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-6234
Mailing Address - Country:US
Mailing Address - Phone:773-494-3653
Mailing Address - Fax:618-239-6353
Practice Address - Street 1:915 N GRAND BLVD
Practice Address - Street 2:A632
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-1621
Practice Address - Country:US
Practice Address - Phone:314-289-4706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology