Healthcare Provider Details

I. General information

NPI: 1336383728
Provider Name (Legal Business Name): AIMEE CHRISTINE TALLEUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 02/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 DANNY THOMAS PL
MEMPHIS TN
38105-3678
US

IV. Provider business mailing address

3196 COWDEN AVE
MEMPHIS TN
38111-3406
US

V. Phone/Fax

Practice location:
  • Phone: 901-595-3006
  • Fax: 901-595-3842
Mailing address:
  • Phone: 518-331-6289
  • Fax: 901-595-3842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number48509
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number48509
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: