Provider Demographics
NPI:1972546059
Name:ISACKSEN, ROBERT R (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:R
Last Name:ISACKSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M206C
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-349-9745
Mailing Address - Fax:269-488-8305
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M206C
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-349-9745
Practice Address - Fax:269-488-8305
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301069750208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
114331OtherGREAT LAKES HLTH PLN
MI3358181-10Medicaid
5735569OtherAETNA PIN
MI3403903262OtherBCBS IND PIN
MI340C910480OtherBCBS GRP PIN
5735569OtherAETNA PIN
MICG4797Medicare PIN
MI340C910480OtherBCBS GRP PIN
383148262OtherEIN-HEALTHCARE MIDWEST
114331OtherGREAT LAKES HLTH PLN