Healthcare Provider Details

I. General information

NPI: 1477563849
Provider Name (Legal Business Name): EILEEN HSICH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EILEEN GLICKSON

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5171 S COTTONWOOD ST
MURRAY UT
84107-5704
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35.085147
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number14296030-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: