Basic Information
| Provider Information | |||||||||
| NPI: | 1952612558 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TALLERICO-ANTONOPOULOS | ||||||||
| FirstName: | VALERIE | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5885 SUNNYBROOK DR | ||||||||
| Address2: | STE E-100 | ||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511064203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122662700 | ||||||||
| FaxNumber: | 7122662718 | ||||||||
| Practice Location | |||||||||
| Address1: | 5885 SUNNYBROOK DR | ||||||||
| Address2: | STE E-100 | ||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511064203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122662700 | ||||||||
| FaxNumber: | 7122662718 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2010 | ||||||||
| LastUpdateDate: | 09/14/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 000870 | IA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213ES0103X | SC006235 | PA | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.