Provider Demographics
NPI:1740243104
Name:ISKANDER, ISIS SAMIR (MD)
Entity Type:Individual
Prefix:
First Name:ISIS
Middle Name:SAMIR
Last Name:ISKANDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1560 E CHEVY CHASE DR
Mailing Address - Street 2:#245
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4197
Mailing Address - Country:US
Mailing Address - Phone:818-246-5900
Mailing Address - Fax:818-956-7633
Practice Address - Street 1:1560 E CHEVY CHASE DR
Practice Address - Street 2:#245
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4197
Practice Address - Country:US
Practice Address - Phone:818-246-5900
Practice Address - Fax:818-956-7633
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA37114207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA84968Medicare UPIN