Provider Demographics
NPI:1861467227
Name:TALLMAN, JONATHAN C (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:C
Last Name:TALLMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5700 BOTTINEAU BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3183
Mailing Address - Country:US
Mailing Address - Phone:763-504-6500
Mailing Address - Fax:763-537-1972
Practice Address - Street 1:5700 BOTTINEAU BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55429-3183
Practice Address - Country:US
Practice Address - Phone:763-504-6500
Practice Address - Fax:763-537-1972
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2012-06-28
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Provider Licenses
StateLicense IDTaxonomies
MN38349207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNG15388Medicare UPIN