Provider Demographics
NPI:1497700124
Name:ISAACS, EDWARD (DO)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:ISAACS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4521 OUTER LOOP
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-3856
Mailing Address - Country:US
Mailing Address - Phone:502-653-5206
Mailing Address - Fax:877-688-0102
Practice Address - Street 1:4521 OUTER LOOP
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-3856
Practice Address - Country:US
Practice Address - Phone:502-653-5206
Practice Address - Fax:877-688-0102
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02356207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0834968Medicaid
KY64023567Medicaid
KYF03887Medicare UPIN
KY0364983Medicare PIN
KYP00421012Medicare PIN