Provider Demographics
NPI:1497597298
Name:ISADA, MICHAEL JOSEPH MAPOY
Entity type:Individual
Prefix:
First Name:MICHAEL JOSEPH
Middle Name:MAPOY
Last Name:ISADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6117 PERCUSSION CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-6886
Mailing Address - Country:US
Mailing Address - Phone:917-815-0403
Mailing Address - Fax:
Practice Address - Street 1:6117 PERCUSSION CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-6886
Practice Address - Country:US
Practice Address - Phone:917-815-0403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVF05240209208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice