Provider Demographics
NPI:1972569556
Name:ISABELL, MASIE VOY (MD)
Entity Type:Individual
Prefix:DR
First Name:MASIE
Middle Name:VOY
Last Name:ISABELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MASIE
Other - Middle Name:VOY
Other - Last Name:ISABELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2559 W. 79TH STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-1751
Mailing Address - Country:US
Mailing Address - Phone:773-737-9555
Mailing Address - Fax:773-737-0401
Practice Address - Street 1:2559 W 79TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-1751
Practice Address - Country:US
Practice Address - Phone:773-737-9555
Practice Address - Fax:773-737-0401
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-24
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.057667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036057667Medicaid
IL036057667Medicaid
ILA49159Medicare UPIN