1457468027 NPI number — MARGARET KERSEY-ISAACSON M.D.

Table of content: MARGARET KERSEY-ISAACSON M.D. (NPI 1457468027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457468027 NPI number — MARGARET KERSEY-ISAACSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KERSEY-ISAACSON
Provider First Name:
MARGARET
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KERSEY
Provider Other First Name:
MARGARET
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457468027
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2925 CHICAGO AVE
Provider Second Line Business Mailing Address:
ALLINA HEALTH
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55407-1321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-262-5000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3024 SNELLING AVE
Provider Second Line Business Practice Location Address:
ALLINA HEALTH EAST LAKE STREET CLINIC
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55406-1911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-775-4900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/23/2006

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: 208000000X , with the licence number:  47221 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080A0000X , with the licence number: 47221 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 12-02997 . This is a "MN MEDICA CHOICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 616R9KE . This is a "BCBS-MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0581595 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 061040200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: J003 . This is a "TRIWEST/CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132340 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1202997 . This is a "MEDICA PRIMARY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2230945 . This is a "ARAZ/PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP46703 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0079611 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1042015 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 34565700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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