Provider Demographics
NPI:1134220270
Name:TALCOTT, JOSEPH PETER (DO)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PETER
Last Name:TALCOTT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 E BELTLINE AVE NE STE 203
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-4598
Mailing Address - Country:US
Mailing Address - Phone:616-734-0900
Mailing Address - Fax:616-734-0890
Practice Address - Street 1:1525 E BELTLINE AVE NE STE 203
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-4598
Practice Address - Country:US
Practice Address - Phone:616-734-0900
Practice Address - Fax:616-734-0890
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI011290207V00000X
MIS101011290207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1654100315OtherBCBSM
MI3157399Medicaid
MI5264772Medicaid
MI3157399Medicaid
MI5264772Medicaid
MIG12606Medicare UPIN