Provider Demographics
NPI:1942272398
Name:ISAAK, SHERRI TEMPLE (MS, CDE)
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:TEMPLE
Last Name:ISAAK
Suffix:
Gender:F
Credentials:MS, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 N MICHIGAN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1244
Mailing Address - Country:US
Mailing Address - Phone:248-763-8107
Mailing Address - Fax:
Practice Address - Street 1:6913 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-9601
Practice Address - Country:US
Practice Address - Phone:574-647-6400
Practice Address - Fax:574-647-2591
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001649A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN37001649AOtherPROFESSONAL LICENSE
IN219570DMedicare ID - Type Unspecified