Provider Demographics
NPI:1245201870
Name:TCACIUC, ISABELLA OSCAR HEDWIG (MD)
Entity Type:Individual
Prefix:DR
First Name:ISABELLA
Middle Name:OSCAR HEDWIG
Last Name:TCACIUC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ISABELLA
Other - Middle Name:
Other - Last Name:TCACIUC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:540 N MARATHON CIR
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1646
Mailing Address - Country:US
Mailing Address - Phone:801-363-6486
Mailing Address - Fax:
Practice Address - Street 1:1020 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84101-3176
Practice Address - Country:US
Practice Address - Phone:801-539-7000
Practice Address - Fax:801-539-7050
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5211300-12052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT863047OtherDESERET MUTUAL
UT107029551101OtherINTERMOUNTAIN HEALTH CARE
UT942938348TCAOtherEDUCATORS MUTUAL
UT107029551101OtherINTERMOUNTAIN HEALTH CARE
UT942938348TCAOtherEDUCATORS MUTUAL
UT002200239Medicare PIN
UTP00195207Medicare ID - Type UnspecifiedRAILROAD MEDICARE