Healthcare Provider Details

I. General information

NPI: 1386639227
Provider Name (Legal Business Name): TARAH TRINITY COLAIZY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 319-356-3508
  • Fax: 319-356-4508
Mailing address:
  • Phone: 319-356-3508
  • Fax: 319-356-4685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number35779
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: