Provider Demographics
NPI:1104827393
Name:TALASILA, HEMA N (MD)
Entity Type:Individual
Prefix:MRS
First Name:HEMA
Middle Name:N
Last Name:TALASILA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEMA
Other - Middle Name:
Other - Last Name:TALASILA MD PLLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2578 MCLEOD DR N SUITE 1
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2859
Mailing Address - Country:US
Mailing Address - Phone:989-799-5440
Mailing Address - Fax:989-799-5651
Practice Address - Street 1:2578 MCLEOD DR N SUITE 1
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2859
Practice Address - Country:US
Practice Address - Phone:989-799-5440
Practice Address - Fax:989-799-5651
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43014063522084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1295917888OtherNPI
MI3184350Medicaid
MI1104827393OtherNPI