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General NPI Number Information
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NPI Number | 1942468459
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Entity Type | Organization
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Legal Business Name | VENKAT TALASILA
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Dates
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Enumeration Date | 05/30/2008
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Last Update Date | 05/30/2008
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Provider Practice Location Address
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Address Line | 200 S WENONA ST STE G29
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City | BAY CITY
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State | MI
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Zip | 48706-8820
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Country | US
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Telephone | 989-893-3212
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Fax | 989-893-0461
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Provider Business Mailing Address
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Address Line | 200 S WENONA ST STE G29
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City | BAY CITY
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State | MI
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Zip | 48706-8820
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Country | US
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Telephone | 989-893-3212
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Fax | 989-893-0461
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. VENKAT TALASILA
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Credential | MD
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Telephone | 989-893-3212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 4301407245
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License Number State | MI
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