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General NPI Number Information
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NPI Number | 1023010808
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Entity Type | Individual
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Provider Name | GIRIDHAR S TALLURI MD
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Gender | Male
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 05/18/2023
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Provider Practice Location Address
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Address Line | 21110 BISCAYNE BLVD STE 403
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City | AVENTURA
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State | FL
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Zip | 33180-1252
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Country | US
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Telephone | 305-918-0742
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Fax | 305-918-0787
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Provider Business Mailing Address
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Address Line | 21110 BISCAYNE BLVD STE 403
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City | AVENTURA
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State | FL
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Zip | 33180-1252
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Country | US
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Telephone | 305-918-0742
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Fax | 305-918-0787
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | ME85266
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License Number State | FL
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