MEDICARE: JONATHAN C. TALLMAN M.D.

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	38349	MN

General Provider Information

NPI Number	:	1861467227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN C. TALLMAN M.D.

Provider Business Mailing Address
First Line	:	5700 BOTTINEAU BLVD
Second Line	:	SUITE 100
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55429-3183
Country	:	US
Telephone Number	:	763-504-6500
Fax Number	:	763-537-1972

Provider Business Practice Location Address
First Line	:	5700 BOTTINEAU BLVD
Second Line	:	SUITE 100
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55429-3183
Country	:	US
Telephone Number	:	763-504-6500
Fax Number	:	763-537-1972

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	06/28/2012

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