MEDICARE: DR. TALIA ZIV PHD

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	103TA0400X	Addiction (Substance Use Disorder) Psychologist	6301010096	MI
2	103TC0700X	Clinical Psychologist	6301010096	MI

General Provider Information

NPI Number	:	1912143108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TALIA ZIV PHD

Provider Business Mailing Address
First Line	:	5745 W MAPLE RD
Second Line	:	STE #218
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4468
Country	:	US
Telephone Number	:	248-855-0222
Fax Number	:	248-855-0239

Provider Business Practice Location Address
First Line	:	5745 W MAPLE RD
Second Line	:	STE #218
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4468
Country	:	US
Telephone Number	:	248-855-0222
Fax Number	:	248-855-0239

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

Provider Enumeration Date	:	12/18/2008
Last Update Date	:	12/18/2008

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