Individual
IZABELA TARASIEWICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
502 MADISON OAK DR STE 346, SAN ANTONIO, TX 78258-4084
(210) 567-6027
Mailing address
7703 FLOYD CURL DR, SAN ANTONIO, TX 78229-3901
(210) 567-6027
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
Q3600
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036115990 1
—
IL
01
—
1627123
BCBS PROVIDER ID
IL
05
—
342823701
—
TX
01
—
342823702
CSHCN
TX
Enumeration date
01/23/2007
Last updated
04/03/2015
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