Provider Demographics
NPI:1538666904
Name:ISAAC, ANDRE (MD)
Entity Type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:
Last Name:ISAAC
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 1:1936 N. CLARK ST , APT 503
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614
Mailing Address - Country:US
Mailing Address - Phone:312-871-7934
Mailing Address - Fax:
Practice Address - Street 1:ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL
Practice Address - Street 2:225 EAST CHICAGO AVE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-227-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-11-28
Deactivation Date:2018-11-16
Deactivation Code:
Reactivation Date:2018-11-28
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program