MEDICARE: YURI TALALAEV 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	207R00000X	Internal Medicine Physician	28484	AZ

General Provider Information

NPI Number	:	1548372089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YURI TALALAEV MD

Provider Business Mailing Address
First Line	:	4672 MAVERICK LN STE 1A
Second Line	:
City	:	LAKESIDE
State	:	AZ
Zip	:	85929-5434
Country	:	US
Telephone Number	:	928-288-0123
Fax Number	:	877-682-6132

Provider Business Practice Location Address
First Line	:	4672 MAVERICK LN STE 1A
Second Line	:
City	:	LAKESIDE
State	:	AZ
Zip	:	85929-5434
Country	:	US
Telephone Number	:	928-288-0123
Fax Number	:	877-682-6132

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	06/01/2026

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