Provider Demographics
NPI:1871530311
Name:TALLET, JULIO (MD)
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:
Last Name:TALLET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8362 PINES BLVD # 287
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6600
Mailing Address - Country:US
Mailing Address - Phone:954-888-8273
Mailing Address - Fax:954-893-6818
Practice Address - Street 1:601 N FLAMINGO RD
Practice Address - Street 2:SUITE 107
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1015
Practice Address - Country:US
Practice Address - Phone:954-436-1205
Practice Address - Fax:954-430-4470
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 88847207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268546900Medicaid
FLG07231Medicare UPIN
FLU1798YMedicare ID - Type Unspecified