MEDICARE: CIARA SHANIS TALBOT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	4301114524	MI
2	207VM0101X	Maternal & Fetal Medicine Physician	88995	GA

General Provider Information

NPI Number	:	1205255056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CIARA SHANIS TALBOT MD

Provider Business Mailing Address
First Line	:	1548 E LAFAYETTE ST APT 340
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-2980
Country	:	US
Telephone Number	:	951-313-0755
Fax Number	:

Provider Business Practice Location Address
First Line	:	1745 PEACHTREE ST NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-2410
Country	:	US
Telephone Number	:	800-611-1811
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2014
Last Update Date	:	01/18/2022

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