Provider Demographics
NPI:1700878600
Name:ISA, MUHAMMAD S (MD)
Entity Type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:S
Last Name:ISA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 ALBANY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62903-7605
Mailing Address - Country:US
Mailing Address - Phone:618-457-5111
Mailing Address - Fax:618-457-6560
Practice Address - Street 1:405 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1462
Practice Address - Country:US
Practice Address - Phone:618-549-0721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9879207L00000X
IL036093948207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036093948Medicaid
H10393Medicare UPIN
ILK07804Medicare ID - Type UnspecifiedMEDICARE