Basic Information
| Provider Information | |||||||||
| NPI: | 1003027939 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ISAACSON | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | MIKAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 PERSHING AVE | ||||||||
| Address2: | |||||||||
| City: | SHENANDOAH | ||||||||
| State: | IA | ||||||||
| PostalCode: | 516012355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122467101 | ||||||||
| FaxNumber: | 7122467340 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 JACK FOSTER DR | ||||||||
| Address2: | |||||||||
| City: | SHENANDOAH | ||||||||
| State: | IA | ||||||||
| PostalCode: | 516014586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122467400 | ||||||||
| FaxNumber: | 7122467334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2007 | ||||||||
| LastUpdateDate: | 10/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 24765 | NE | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 38928 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.