Provider Demographics
NPI:1457627754
Name:ISABELL, ANWAR R (MD)
Entity Type:Individual
Prefix:DR
First Name:ANWAR
Middle Name:R
Last Name:ISABELL
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 1:818 FOREST LN
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185-4585
Mailing Address - Country:US
Mailing Address - Phone:262-514-8199
Mailing Address - Fax:
Practice Address - Street 1:818 FOREST LN
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:WI
Practice Address - Zip Code:53185-4585
Practice Address - Country:US
Practice Address - Phone:262-514-8199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI64946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1457627754Medicaid
WI1457627754Medicaid