Provider Demographics
NPI:1619254695
Name:DONNA J TAL MD PC
Entity Type:Organization
Organization Name:DONNA J TAL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:TAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-434-7400
Mailing Address - Street 1:5333 MCAULEY DR
Mailing Address - Street 2:STE 6015
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197
Mailing Address - Country:US
Mailing Address - Phone:734-434-7400
Mailing Address - Fax:734-434-7323
Practice Address - Street 1:5333 MCAULEY DR
Practice Address - Street 2:STE 6015
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197
Practice Address - Country:US
Practice Address - Phone:734-434-7400
Practice Address - Fax:734-434-7323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty