Provider Demographics
NPI:1780763250
Name:SAAREL, ELIZABETH VICKERS (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:VICKERS
Last Name:SAAREL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:CROSBY
Other - Last Name:VICKERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:520 S EAGLE RD STE 2204
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6351
Mailing Address - Country:US
Mailing Address - Phone:208-336-9188
Mailing Address - Fax:208-336-2636
Practice Address - Street 1:100 MARIO CAPECCHI DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1103
Practice Address - Country:US
Practice Address - Phone:801-662-5400
Practice Address - Fax:801-662-5414
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-10382208000000X, 2080P0202X, 207RA0002X
UT5957969-12052080P0202X
OH35.0830152080P0202X
WY7575A2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0002XAllopathic & Osteopathic PhysiciansInternal MedicineAdult Congenital Heart Disease
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology