Provider Demographics
NPI:1093259228
Name:ISSAC, ROBERT SOLOMON (NP-C)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:SOLOMON
Last Name:ISSAC
Suffix:
Gender:M
Credentials:NP-C
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Mailing Address - Street 1:5701 BOW POINTE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-3199
Mailing Address - Country:US
Mailing Address - Phone:248-625-2621
Mailing Address - Fax:248-625-2622
Practice Address - Street 1:44200 WOODWARD AVE STE 112
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5046
Practice Address - Country:US
Practice Address - Phone:248-384-8100
Practice Address - Fax:248-384-8101
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2025-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704272827363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner