Healthcare Provider Details

I. General information

NPI: 1710427000
Provider Name (Legal Business Name): PAMELA TALLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3627 W VERNOR HWY
DETROIT MI
48216-1440
US

IV. Provider business mailing address

1500 OCHER ST
NOVI MI
48374-1112
US

V. Phone/Fax

Practice location:
  • Phone: 313-297-2975
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: