MEDICARE: DR. ELISABETH A FERLIC M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	42235	AZ
2	208800000X	Urology Physician	036178081	IL
3	208800000X	Urology Physician	56312	MN
4	208800000X	Urology Physician	9017811-1205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114185634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELISABETH A FERLIC M.D.

Provider Business Mailing Address
First Line	:	9720 S 1300 E
Second Line	:	SUITE E230
City	:	SANDY
State	:	UT
Zip	:	84094-3712
Country	:	US
Telephone Number	:	801-501-2950
Fax Number	:	801-501-2951

Provider Business Practice Location Address
First Line	:	9720 S 1300 E
Second Line	:	SUITE E230
City	:	SANDY
State	:	UT
Zip	:	84094-3712
Country	:	US
Telephone Number	:	801-501-2950
Fax Number	:	801-501-2951

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2008
Last Update Date	:	02/04/2026

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