Provider Demographics
NPI:1013080241
Name:TALI, ARDITA
Entity Type:Individual
Prefix:DR
First Name:ARDITA
Middle Name:
Last Name:TALI
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ARDITA
Other - Middle Name:
Other - Last Name:LLESHI-TALI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12561 DUNCAN LN UNIT 201
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-8794
Mailing Address - Country:US
Mailing Address - Phone:312-451-8451
Mailing Address - Fax:
Practice Address - Street 1:12561 DUNCAN LN UNIT 201
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-8794
Practice Address - Country:US
Practice Address - Phone:312-451-8451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine