Provider Demographics
NPI:1588652416
Name:ISAAC, GEORGE BEHNAM (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:BEHNAM
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 1:2140 JOHN F KENNEDY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-3883
Mailing Address - Country:US
Mailing Address - Phone:563-583-4848
Mailing Address - Fax:563-690-1304
Practice Address - Street 1:2140 JOHN F KENNEDY RD
Practice Address - Street 2:SUITE B
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-3883
Practice Address - Country:US
Practice Address - Phone:563-583-4848
Practice Address - Fax:563-690-1304
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32128174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA35121OtherBLUE CROSS BLUE SHIELD
IA1159236Medicaid
IAI10239Medicare ID - Type Unspecified
IA1159236Medicaid