1639159833 NPI number — DR. SANJAI ISAAC M.D.

Table of content: DR. SANJAI ISAAC M.D. (NPI 1639159833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639159833 NPI number — DR. SANJAI ISAAC M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ISAAC
Provider First Name:
SANJAI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639159833
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3308 PRESTON RD 350-287
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75093-7453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-471-5975
Provider Business Mailing Address Fax Number:
866-476-1204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 WOODCOCK RD STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32803-3509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-792-1968
Provider Business Practice Location Address Fax Number:
407-641-5179
Provider Enumeration Date:
01/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  J6498 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: J6498 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: ME158582 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200217850A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 116830900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 14005729 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 116830900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".