Provider Demographics
NPI:1336667187
Name:AMAR TALATI, DO, LLC
Entity Type:Organization
Organization Name:AMAR TALATI, DO, LLC
Other - Org Name:INTEGRATIVE DIRECT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:TALATI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:205-267-8653
Mailing Address - Street 1:2901 1ST AVE N STE 301
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8640
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2901 1ST AVE N STE 301
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8640
Practice Address - Country:US
Practice Address - Phone:727-317-6549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty