Provider Demographics
NPI:1821244377
Name:ISAC, WAHIB E (MD)
Entity Type:Individual
Prefix:DR
First Name:WAHIB
Middle Name:E
Last Name:ISAC
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:33100 CLEVELAND CLINIC BLVD./AVW2-2 RICHARD E. JACOBS H
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011
Mailing Address - Country:US
Mailing Address - Phone:440-695-4000
Mailing Address - Fax:440-695-4619
Practice Address - Street 1:33100 CLEVELAND CLINIC BLVD./AVW2-2 RICHARD E. JACOBS H
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011
Practice Address - Country:US
Practice Address - Phone:440-695-4000
Practice Address - Fax:440-695-4619
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA205660208800000X
OH350959672088P0231X
OH35.095967208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2306251Medicaid
LA249924YH5Medicare PIN