MEDICARE: MR. DANIEL LOUIS TALLERICO 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	10585	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568443638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL LOUIS TALLERICO MD

Provider Business Mailing Address
First Line	:	5300 N INDEPENDENCE AVE
Second Line	:	SUITE 280
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-5556
Country	:	US
Telephone Number	:	405-657-3950
Fax Number	:	405-471-0040

Provider Business Practice Location Address
First Line	:	4833 INTEGRIS PKWY
Second Line	:	SUITE 200
City	:	EDMOND
State	:	OK
Zip	:	73034-8864
Country	:	US
Telephone Number	:	405-657-3950
Fax Number	:	405-471-0040

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	02/08/2016

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