Provider Demographics
NPI:1851385462
Name:ISAACS, RANDY R (MD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:R
Last Name:ISAACS
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 1:3200 E RACINE ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-2343
Mailing Address - Country:US
Mailing Address - Phone:608-371-8000
Mailing Address - Fax:608-371-8919
Practice Address - Street 1:3200 E RACINE ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546
Practice Address - Country:US
Practice Address - Phone:608-371-8000
Practice Address - Fax:608-371-8919
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI70133-20208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1851385462Medicaid
116418OtherBETTER HEALTH PLAN
11799OtherTLC
TN4176780OtherBCBS
1240740OtherUNITED HEALTHCARE
2447323OtherCIGNA
TN3128563OtherBLUE CROSS
370014540OtherPALMETTO GBA
116418OtherBETTER HEALTH PLAN
1240740OtherUNITED HEALTHCARE
3844226Medicare ID - Type Unspecified