Provider Demographics
NPI:1134315872
Name:ISENBERG, PHILIP NATHANAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:NATHANAEL
Last Name:ISENBERG
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 1:7495 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-2013
Mailing Address - Country:US
Mailing Address - Phone:801-213-9400
Mailing Address - Fax:801-213-9458
Practice Address - Street 1:7495 S STATE ST
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-2013
Practice Address - Country:US
Practice Address - Phone:801-213-9400
Practice Address - Fax:801-213-9458
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6353681-1205207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics