Provider Demographics
NPI:1932126752
Name:TALLA, SARVESWARARAO (MD)
Entity Type:Individual
Prefix:DR
First Name:SARVESWARARAO
Middle Name:
Last Name:TALLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17356 W 12 MILE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2128
Mailing Address - Country:US
Mailing Address - Phone:248-552-1220
Mailing Address - Fax:248-552-8331
Practice Address - Street 1:17356 W 12 MILE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2128
Practice Address - Country:US
Practice Address - Phone:248-552-1220
Practice Address - Fax:248-552-8331
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIST039318208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics