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General NPI Number Information
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NPI Number | 1841221173
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Entity Type | Individual
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Provider Name | JOHN JOSEPH TAGLIA MD
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Gender | Male
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 11/10/2022
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Provider Practice Location Address
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Address Line | 7808 W COLLEGE DR STE 2W
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1098
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Country | US
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Telephone | 708-631-5110
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 NILES AVE
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-1584
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Country | US
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Telephone | 773-531-1747
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036161593
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License Number State | IL
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