Healthcare Provider Details

I. General information

NPI: 1902863863
Provider Name (Legal Business Name): LOUIS J TALLO D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 S CLINTON AVE
ROCHESTER NY
14618-2623
US

IV. Provider business mailing address

2225 S CLINTON AVE
ROCHESTER NY
14618-2623
US

V. Phone/Fax

Practice location:
  • Phone: 585-473-5051
  • Fax:
Mailing address:
  • Phone: 585-473-5051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN003613-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: