Provider Demographics
NPI:1104976109
Name:MARAR, ISAM ELIAS (MD)
Entity type:Individual
Prefix:
First Name:ISAM
Middle Name:ELIAS
Last Name:MARAR
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 1:1701 WEST BOADWAY
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501
Mailing Address - Country:US
Mailing Address - Phone:712-256-5600
Mailing Address - Fax:712-256-3440
Practice Address - Street 1:1701 WEST BOADWAY
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501
Practice Address - Country:US
Practice Address - Phone:712-256-5600
Practice Address - Fax:712-256-3440
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32105207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3160903Medicaid
IAI1059Medicare PIN
IB1041002Medicare UPIN
IA41453Medicare PIN