Provider Demographics
NPI:1457458770
Name:CADDELL, TATJANA (MD)
Entity Type:Individual
Prefix:DR
First Name:TATJANA
Middle Name:
Last Name:CADDELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WARM SPRINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59756
Mailing Address - Country:US
Mailing Address - Phone:406-693-7142
Mailing Address - Fax:406-693-7069
Practice Address - Street 1:1MAIN ST
Practice Address - Street 2:
Practice Address - City:WARM SPRINGS
Practice Address - State:MT
Practice Address - Zip Code:59756
Practice Address - Country:US
Practice Address - Phone:406-693-7142
Practice Address - Fax:406-693-7069
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT48242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTF88475Medicare UPIN