Provider Demographics
NPI:1942468459
Name:VENKAT TALASILA
Entity Type:Organization
Organization Name:VENKAT TALASILA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VENKAT
Authorized Official - Middle Name:
Authorized Official - Last Name:TALASILA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-893-3212
Mailing Address - Street 1:200 S WENONA ST
Mailing Address - Street 2:STE G29
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-8820
Mailing Address - Country:US
Mailing Address - Phone:989-893-3212
Mailing Address - Fax:989-893-0461
Practice Address - Street 1:200 S WENONA ST
Practice Address - Street 2:STE G29
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-8820
Practice Address - Country:US
Practice Address - Phone:989-893-3212
Practice Address - Fax:989-893-0461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301407245101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI103117160Medicaid
MI2600731330OtherBC
MI0M08820Medicare PIN