Provider Demographics
NPI: | 1639129281 |
---|---|
Name: | ISAAK, FREDERICK SIMON (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | FREDERICK |
Middle Name: | SIMON |
Last Name: | ISAAK |
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: | 1500 ASSOCIATES DR |
Mailing Address - Street 2: | |
Mailing Address - City: | DUBUQUE |
Mailing Address - State: | IA |
Mailing Address - Zip Code: | 52002-2201 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 563-584-4100 |
Mailing Address - Fax: | 563-584-4110 |
Practice Address - Street 1: | 1000 LANGWORTHY ST |
Practice Address - Street 2: | |
Practice Address - City: | DUBUQUE |
Practice Address - State: | IA |
Practice Address - Zip Code: | 52001-7313 |
Practice Address - Country: | US |
Practice Address - Phone: | 563-584-3455 |
Practice Address - Fax: | 563-584-3177 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-05-12 |
Last Update Date: | 2008-04-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IA | 28293 | 207P00000X, 2083X0100X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | |
No | 2083X0100X | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IA | 0189407 | Medicaid | |
IA | 0189407 | Medicaid | |
IA | 02726 | Medicare ID - Type Unspecified |