Provider Demographics
NPI:1083400733
Name:TADE, ISAAC LARSEN
Entity type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:LARSEN
Last Name:TADE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 MALCOLM AVE SE APT 4
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3545
Mailing Address - Country:US
Mailing Address - Phone:507-589-9171
Mailing Address - Fax:
Practice Address - Street 1:450 KILAUEA AVE STE 105
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3089
Practice Address - Country:US
Practice Address - Phone:808-333-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program