Provider Demographics
NPI:1194105064
Name:VAN SLIGTENHORST, ISAAC (MD)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:VAN SLIGTENHORST
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 1:920 FROSTWOOD DR STE 2.300
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2314
Mailing Address - Country:US
Mailing Address - Phone:713-338-5519
Mailing Address - Fax:
Practice Address - Street 1:4057 RILEY FUZZEL RD STE 1100A
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-4632
Practice Address - Country:US
Practice Address - Phone:281-602-0440
Practice Address - Fax:281-602-0445
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS2188207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program