Provider Demographics
NPI:1417081282
Name:ISAKOV KYRIAKAKIS, INGRID L (MD)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:L
Last Name:ISAKOV KYRIAKAKIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:INGRID
Other - Middle Name:L
Other - Last Name:ISAKOV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2000 E GREENVILLE ST
Mailing Address - Street 2:SUITE #1600
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1580
Mailing Address - Country:US
Mailing Address - Phone:864-716-6008
Mailing Address - Fax:864-716-6732
Practice Address - Street 1:2000 E GREENVILLE ST
Practice Address - Street 2:SUITE #1600
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1580
Practice Address - Country:US
Practice Address - Phone:864-716-6008
Practice Address - Fax:864-716-6732
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22171207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC221717Medicaid
SC221717Medicaid
SCH30374Medicare UPIN