National Provider Identifier Database

TIMOTHY B ICENOGLE, MD – NPI #1285683029
Thoracic Surgery (Cardiothoracic Vascular Surgery)

A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty.


Contact Information

TIMOTHY B ICENOGLE, MD
4403 HARRISON BLVD STE 3835
OGDEN, UT84403-3331
Phone: 801-387-3475
Fax: 801-387-3480
Website:
Specialty Taxonomy Code
* Thoracic Surgery (Cardiothoracic Vascular Surgery) 208G00000X
Transplant Surgery 204F00000X

* Indicates primary specialty

NPI Profile & details for TIMOTHY B ICENOGLE

NPI Number 1285683029
Credentials MD
Entity Individual
Enumeration date 05/09/2006
Last updated 12/13/2022 - About 3 years ago
Sole proprietor1 No
Identifiers
  • TX License #: S9004
  • UT License #: 126770044-1205
  • WA License #: MD00026659
  • ID Medicaid: 3756900
  • MT Medicaid: 3505645
  • WA Medicaid: 1072495
Hospital affiliation n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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