Provider Demographics
NPI:1184945180
Name:ISAM FELAHY M D INC
Entity type:Organization
Organization Name:ISAM FELAHY M D INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ISAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FELAHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-466-3457
Mailing Address - Street 1:2800 N CALIFORNIA ST
Mailing Address - Street 2:SUITE 15
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-3757
Mailing Address - Country:US
Mailing Address - Phone:209-466-3457
Mailing Address - Fax:209-466-1229
Practice Address - Street 1:2800 N CALIFORNIA ST
Practice Address - Street 2:SUITE 15
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-3757
Practice Address - Country:US
Practice Address - Phone:209-466-3457
Practice Address - Fax:209-466-1229
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ISAM FELAHY MD FRCS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-14
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25226208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1109416Medicaid
CA00A252260Medicare PIN
CAA24335Medicare UPIN