Provider Demographics
NPI:1497729222
Name:ISAKOV, TERENCE (MD)
Entity Type:Individual
Prefix:MR
First Name:TERENCE
Middle Name:
Last Name:ISAKOV
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 1:5187 MAYFIELD RD
Mailing Address - Street 2:STE 102
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124
Mailing Address - Country:US
Mailing Address - Phone:440-449-1014
Mailing Address - Fax:440-449-8157
Practice Address - Street 1:5187 MAYFIELD RD
Practice Address - Street 2:STE 102
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124
Practice Address - Country:US
Practice Address - Phone:440-449-1014
Practice Address - Fax:440-449-8157
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35042704207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0376141Medicaid
OH1497729222OtherNPI
OHIS0451222Medicare ID - Type Unspecified
OH1497729222OtherNPI