Provider Demographics
NPI:1760522460
Name:IZENSON, HOWARD ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:ALLEN
Last Name:IZENSON
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 1:912 FOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4847
Mailing Address - Country:US
Mailing Address - Phone:630-248-1254
Mailing Address - Fax:847-940-9532
Practice Address - Street 1:912 FOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4847
Practice Address - Country:US
Practice Address - Phone:630-248-1254
Practice Address - Fax:847-940-9532
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-059939207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-059939OtherPHYSICIAN LICENSE
IN200899740Medicaid
IN000000564544OtherANTHEM
IN01062800AOtherPHYSICIAN LICENSE
IN000000564544OtherANTHEM
IN01062800AOtherPHYSICIAN LICENSE
IN01062800AOtherPHYSICIAN LICENSE
IN200899740Medicaid
INFI0047096OtherDEA REGISTRATION