Provider Demographics
NPI:1730355405
Name:DR. S.RAO TALLA
Entity type:Organization
Organization Name:DR. S.RAO TALLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:S.RAO
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-552-1220
Mailing Address - Street 1:17356 W 12 MILE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2128
Mailing Address - Country:US
Mailing Address - Phone:248-552-1220
Mailing Address - Fax:248-552-8331
Practice Address - Street 1:17356 W 12 MILE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2128
Practice Address - Country:US
Practice Address - Phone:248-552-1220
Practice Address - Fax:248-552-8331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty