Healthcare Provider Details

I. General information

NPI: 1942309455
Provider Name (Legal Business Name): JOHN D TALBOTT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 W MITCHELL ST STE 400 MHVS CARDIOVASCULAR & THORACIC SURGER
PETOSKEY MI
49770-2274
US

IV. Provider business mailing address

416 CONNABLE
PETOSKEY MI
49770
US

V. Phone/Fax

Practice location:
  • Phone: 231-487-4950
  • Fax: 231-487-4951
Mailing address:
  • Phone: 231-487-7129
  • Fax: 231-487-3082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number5101010171
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: