Basic Information
| Provider Information | |||||||||
| NPI: | 1336508266 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ISENSTADT | ||||||||
| FirstName: | JESSE | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3333 GRAND AVE APT 215 | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503124109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6232569604 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3810 PLAZA WAY | ||||||||
| Address2: | |||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993382722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092217000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2016 | ||||||||
| LastUpdateDate: | 10/07/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OS020199 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.