Provider Demographics
NPI:1235935479
Name:AMANULLAEV, TALIB
Entity type:Individual
Prefix:MR
First Name:TALIB
Middle Name:
Last Name:AMANULLAEV
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27378 PARKVIEW BLVD APT 4314
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-3501
Mailing Address - Country:US
Mailing Address - Phone:586-525-8712
Mailing Address - Fax:
Practice Address - Street 1:27378 PARKVIEW BLVD APT 4314
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-3501
Practice Address - Country:US
Practice Address - Phone:586-339-2178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth Educator
No171M00000XOther Service ProvidersCase Manager/Care Coordinator