Basic Information
| Provider Information | |||||||||
| NPI: | 1942309455 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TALBOTT | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 416 CONNABLE | ||||||||
| Address2: | |||||||||
| City: | PETOSKEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2314877129 | ||||||||
| FaxNumber: | 2314873082 | ||||||||
| Practice Location | |||||||||
| Address1: | 560 W MITCHELL ST STE 400 | ||||||||
| Address2: | MHVS CARDIOVASCULAR & THORACIC SURGER | ||||||||
| City: | PETOSKEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497702274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2314874950 | ||||||||
| FaxNumber: | 2314874951 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 01/23/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | 5101010171 | MI | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 4853893 | 05 | MI | MEDICAID | 533089 | 01 | MI | BCBS INDIVIDUAL PIN | OTHER |