Provider Demographics
NPI:1609625367
Name:ISOME, MIKEL
Entity type:Individual
Prefix:
First Name:MIKEL
Middle Name:
Last Name:ISOME
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 LINN ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45214-2270
Mailing Address - Country:US
Mailing Address - Phone:513-673-1952
Mailing Address - Fax:
Practice Address - Street 1:2021 LINN ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45214-2270
Practice Address - Country:US
Practice Address - Phone:513-673-1952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities