Provider Demographics
NPI:1164912572
Name:TALSMA, NICOLAS (DO)
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:
Last Name:TALSMA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-5504
Mailing Address - Country:US
Mailing Address - Phone:253-330-9455
Mailing Address - Fax:
Practice Address - Street 1:28100 GRAND RIVER AVE STE 313
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-5970
Practice Address - Country:US
Practice Address - Phone:248-615-7150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101023896207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine