Provider Demographics
NPI:1538313929
Name:ELLCHUK, TASHA NICOLE (BSC, MD, FRCPC)
Entity Type:Individual
Prefix:DR
First Name:TASHA
Middle Name:NICOLE
Last Name:ELLCHUK
Suffix:
Gender:F
Credentials:BSC, MD, FRCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF RADIOLOGY 30 NORTH 1900 E
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0001
Mailing Address - Country:US
Mailing Address - Phone:801-581-4626
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF RADIOLOGY 30 NORTH 1900 E
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-581-4626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7057751-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist