Provider Demographics
NPI:1154323590
Name:ISAACSON, RICHARD LEE (DPM)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LEE
Last Name:ISAACSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:L
Other - Last Name:ISAACSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:2020 W 86TH ST
Mailing Address - Street 2:108
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1931
Mailing Address - Country:US
Mailing Address - Phone:317-872-0984
Mailing Address - Fax:317-872-0349
Practice Address - Street 1:2020 W 86TH ST
Practice Address - Street 2:108
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1931
Practice Address - Country:US
Practice Address - Phone:317-872-0984
Practice Address - Fax:317-872-0349
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000414A213E00000X, 213ES0103X, 213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100061710 A & BMedicaid
IN077400Medicare PIN
INT34525Medicare UPIN
IN0956230001Medicare NSC
IN082170Medicare PIN