Provider Demographics
NPI:1356830855
Name:BERKI, TALLAT MAMOON (SA-C)
Entity Type:Individual
Prefix:MRS
First Name:TALLAT
Middle Name:MAMOON
Last Name:BERKI
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:TALLAT
Other - Middle Name:
Other - Last Name:MAMOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:366 CORALYNN CT
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-1895
Mailing Address - Country:US
Mailing Address - Phone:630-346-8470
Mailing Address - Fax:
Practice Address - Street 1:366 CORALYNN CT
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-1895
Practice Address - Country:US
Practice Address - Phone:630-346-8470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant