Provider Demographics
NPI:1609919539
Name:JOSEPH G. TALBERT, M.D., PLLC
Entity Type:Organization
Organization Name:JOSEPH G. TALBERT, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:G
Authorized Official - Last Name:TALBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PLLC
Authorized Official - Phone:313-993-7010
Mailing Address - Street 1:4160 JOHN R ST
Mailing Address - Street 2:SUITE 1011
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2020
Mailing Address - Country:US
Mailing Address - Phone:313-993-7010
Mailing Address - Fax:313-993-7012
Practice Address - Street 1:4160 JOHN R ST
Practice Address - Street 2:SUITE 1011
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2020
Practice Address - Country:US
Practice Address - Phone:313-993-7010
Practice Address - Fax:313-993-7012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI035210246X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2124624Medicaid
MION97130Medicare ID - Type Unspecified
MI2124624Medicaid