Provider Demographics
NPI:1841231941
Name:ISAAC, HERBERT II (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:
Last Name:ISAAC
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:989 UNIVERSITY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-1885
Mailing Address - Country:US
Mailing Address - Phone:248-334-4773
Mailing Address - Fax:248-337-8230
Practice Address - Street 1:989 UNIVERSITY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-1885
Practice Address - Country:US
Practice Address - Phone:248-334-4773
Practice Address - Fax:248-337-8230
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301073786207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0106354002OtherBLUE CROSS AND BLUE SHIELD
MI4301073786OtherSTATE LICENSE
MIH19882Medicare UPIN
MI0106354002OtherBLUE CROSS AND BLUE SHIELD