Basic Information
Provider Information
NPI: 1770506016
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ISELY
FirstName: KAREL
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1185 LAUREL AVE
Address2:  
City: SAINT PAUL
State: MN
PostalCode: 551046926
CountryCode: US
TelephoneNumber: 6512244755
FaxNumber:  
Practice Location
Address1: 69 EXCHANGE ST W
Address2:  
City: SAINT PAUL
State: MN
PostalCode: 551021004
CountryCode: US
TelephoneNumber: 6512323000
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/26/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X44551MNY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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