Provider Demographics
NPI:1942309455
Name:TALBOTT, JOHN D (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:TALBOTT
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:416 CONNABLE
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770
Mailing Address - Country:US
Mailing Address - Phone:231-487-7129
Mailing Address - Fax:231-487-3082
Practice Address - Street 1:560 W MITCHELL ST STE 400
Practice Address - Street 2:MHVS CARDIOVASCULAR & THORACIC SURGER
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2274
Practice Address - Country:US
Practice Address - Phone:231-487-4950
Practice Address - Fax:231-487-4951
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2014-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101010171208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4853893Medicaid
MI533089OtherBCBS INDIVIDUAL PIN
MI0M73150038Medicare PIN
MI4853893Medicaid