1164425112 NPI number — DR. BRIAN JOHN ISETTS B.C.P.S., PH.D.

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	ISETTS
Provider First Name	:	BRIAN
Provider Middle Name	:	JOHN
Provider Name Prefix Text	:	DR.
Provider Name Suffix Text	:
Provider Credential Text	:	B.C.P.S., PH.D.
Provider Gender Code	:	M

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NPI Number	:	1164425112
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	07/08/2007
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Provider First Line Business Mailing Address	:	3510 WILD TURKEY RD
Provider Second Line Business Mailing Address	:
Provider Business Mailing Address City Name	:	RED WING
Provider Business Mailing Address State Name	:	MN
Provider Business Mailing Address Postal Code	:	550661765
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	6513858353
Provider Business Mailing Address Fax Number	:

Provider First Line Business Practice Location Address	:	308 HARVARD ST SE
Provider Second Line Business Practice Location Address	:	RM 7-175
Provider Business Practice Location Address City Name	:	MINNEAPOLIS
Provider Business Practice Location Address State Name	:	MN
Provider Business Practice Location Address Postal Code	:	554550353
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	6126242140
Provider Business Practice Location Address Fax Number	:	6126259931
Provider Enumeration Date	:	05/23/2005

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• Taxonomy code: 1835P1200X , with the licence number:  113541-1 , registered in the state of MN .