Provider Demographics
NPI:1376220160
Name:ISKANDER, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:ISKANDER
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 1:4 MEMORIAL DRIVE
Mailing Address - Street 2:OFFICE BUILDING B SUITE 115
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6705
Mailing Address - Country:US
Mailing Address - Phone:618-468-1523
Mailing Address - Fax:
Practice Address - Street 1:4 MEMORIAL DRIVE
Practice Address - Street 2:OFFICE BUILDING B SUITE 115
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6705
Practice Address - Country:US
Practice Address - Phone:618-468-1523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.082109207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine