Provider Demographics
NPI:1558379008
Name:ISADORE, ERNEST V (DPM)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:V
Last Name:ISADORE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 DEAN STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175
Mailing Address - Country:US
Mailing Address - Phone:630-377-5001
Mailing Address - Fax:630-377-5021
Practice Address - Street 1:2210 DEAN STREET
Practice Address - Street 2:SUITE C
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175
Practice Address - Country:US
Practice Address - Phone:630-377-5001
Practice Address - Fax:630-377-5021
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-002699213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363432665OtherTAX ID STC
IL480028367OtherRR MEDICARE
IL0004515235OtherBCBS STC
IL60100844OtherBCBS-AUR
IL60100844OtherBCBS-AUR
IL480028367OtherRR MEDICARE
ILT36193Medicare UPIN
ILK52571Medicare PIN