Healthcare Provider Details

I. General information

NPI: 1265403836
Provider Name (Legal Business Name): WALTER JOSEPH TALAMONTI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AMERICAN RD WHQ SUITE 513
DEARBORN MI
48126-2701
US

IV. Provider business mailing address

1 AMERICAN RD WHQ SUITE 513
DEARBORN MI
48126-2701
US

V. Phone/Fax

Practice location:
  • Phone: 313-323-9210
  • Fax: 313-390-0354
Mailing address:
  • Phone: 313-323-9210
  • Fax: 313-390-0354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number4301047687
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: