MEDICARE: M TERESA TALLON 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	207Q00000X	Family Medicine Physician	01039505	IN
2	207V00000X	Obstetrics & Gynecology Physician	01039505	IN

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
2	000000089022	OTHER	IN	ANTHEM BCBS

General Provider Information

NPI Number	:	1649262155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	M TERESA TALLON MD

Provider Business Mailing Address
First Line	:	2821 E DUPONT RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1668
Country	:	US
Telephone Number	:	260-497-0602
Fax Number	:	260-497-0657

Provider Business Practice Location Address
First Line	:	2821 E DUPONT RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1668
Country	:	US
Telephone Number	:	260-497-0602
Fax Number	:	260-497-0657

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	08/23/2011

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Directions to “ M TERESA TALLON MD” Practice Location

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