Provider Demographics
NPI:1134134794
Name:TALLIO, DEBORA GAIL (MD)
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:GAIL
Last Name:TALLIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2387 PROFESSIONAL HEIGHTS DR STE 130
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3038
Mailing Address - Country:US
Mailing Address - Phone:859-687-6070
Mailing Address - Fax:859-687-6071
Practice Address - Street 1:2387 PROFESSIONAL HEIGHTS DR STE 130
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3038
Practice Address - Country:US
Practice Address - Phone:859-687-6070
Practice Address - Fax:859-687-6071
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39006208100000X, 2081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY37903705OtherMEDICAID LAB GROUP
P00184664OtherRR MEDICARE PIN
CB5773OtherRR MEDICARE GROUP
KY64088677Medicaid
KY4000501OtherMEDICARE LAB GROUP
KY4000501OtherMEDICARE LAB GROUP
KY4000501OtherMEDICARE LAB GROUP