Individual
PRASANNA ISAAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7836 W JEFFERSON BLVD STE 101, FORT WAYNE, IN 46804-4178
(260) 494-3484
(260) 471-5507
Mailing address
120 W 22ND ST, OAK BROOK, IL 60523-1557
(630) 573-5000
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
01067936A
IN
207RN0300X
Nephrology Physician
35.095468
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1012980
—
LA
05
—
1021263090001
—
PA
05
—
200977120
—
IN
05
—
2925099
—
OH
Enumeration date
06/18/2007
Last updated
08/15/2024
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