Healthcare Provider Details

I. General information

NPI: 1700378437
Provider Name (Legal Business Name): TALEM TECHNOLOGIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 RENAISSANCE CTR STE 2900
DETROIT MI
48243-1602
US

IV. Provider business mailing address

400 RENAISSANCE CTR STE 2900
DETROIT MI
48243-1602
US

V. Phone/Fax

Practice location:
  • Phone: 313-262-3370
  • Fax:
Mailing address:
  • Phone: 313-262-3370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: BLAKE MATHIE
Title or Position: PRESIDENT
Credential:
Phone: 313-748-7534