Provider Demographics
NPI:1275546913
Name:TALLO, CHRISTOPHER PHILIP (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:PHILIP
Last Name:TALLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 EAST DUPONT ROAD
Mailing Address - Street 2:SUITE 236
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825
Mailing Address - Country:US
Mailing Address - Phone:260-490-8022
Mailing Address - Fax:260-490-8035
Practice Address - Street 1:2510 EAST DUPONT ROAD
Practice Address - Street 2:SUITE 236
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825
Practice Address - Country:US
Practice Address - Phone:260-490-8022
Practice Address - Fax:260-490-8035
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0144949208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ING27810Medicare UPIN