Provider Demographics
NPI:1265533988
Name:ISENHOWER, DOMINIQUE E (MD)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:E
Last Name:ISENHOWER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2218 BELLEFONTAINE ST
Mailing Address - Street 2:UNIT C
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3269
Mailing Address - Country:US
Mailing Address - Phone:713-795-9500
Mailing Address - Fax:713-795-9590
Practice Address - Street 1:7400 FANNIN ST
Practice Address - Street 2:SUITE 900
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1920
Practice Address - Country:US
Practice Address - Phone:713-795-9500
Practice Address - Fax:713-795-9590
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK9574208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H49295Medicare UPIN