Provider Demographics
NPI:1891773123
Name:ISACOFF, WILLIAM H (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:H
Last Name:ISACOFF
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 1:2811 WILSHIRE BLVD STE 414
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4804
Mailing Address - Country:US
Mailing Address - Phone:310-824-4133
Mailing Address - Fax:310-201-6685
Practice Address - Street 1:2811 WILSHIRE BLVD STE 414
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4804
Practice Address - Country:US
Practice Address - Phone:310-824-4133
Practice Address - Fax:310-201-6685
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG24596207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G245960Medicaid
CAZZZ 66561 ZOtherBLUE SHIELD OF CA DME
CA953490494OtherCOMMERICAL PROV ID
CA90024B002OtherTRICARE PROV ID
CA00G245960Medicaid
CA90024B002OtherTRICARE PROV ID
CAZZZ 66561 ZOtherBLUE SHIELD OF CA DME
CAG24596Medicare ID - Type Unspecified