Provider Demographics
NPI:1104884311
Name:ISAACSON, THOMAS C (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:ISAACSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:
Practice Address - Street 1:10105 BANBURRY CROSS DR STE 250
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-6648
Practice Address - Country:US
Practice Address - Phone:702-360-7600
Practice Address - Fax:702-363-3814
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4664207RC0000X, 207RI0011X
NV19546207RI0011X
WI32847207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
103715OtherUCARE
MN51B19ISOtherMN BCBS
MN538R81ISOtherMN BLUE SHIELD
MN143763100Medicaid
931451029037OtherPREFERRED ONE
IA0529776Medicaid
SD0006848OtherSD BCBS
25-00471OtherSELECTCARE
SD60057719Medicaid
IA25118OtherIA BCBS
35614OtherHEALTH PARTNERS
25-00471OtherSELECTCARE
IA0529776Medicaid
931451029037OtherPREFERRED ONE
GA060057719Medicare PIN
SDS6848Medicare PIN