Provider Demographics
NPI:1376634048
Name:ISAACSON, FREDERICK MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:MICHAEL
Last Name:ISAACSON
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 1:1451 GREEN HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7492
Mailing Address - Country:US
Mailing Address - Phone:615-587-0845
Mailing Address - Fax:
Practice Address - Street 1:1451 GREEN HILL BLVD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7492
Practice Address - Country:US
Practice Address - Phone:615-587-0845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD290532085R0202X
TN29053208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNC60157Medicare UPIN