Provider Demographics
NPI:1295917888
Name:HEMA TALASILA MD PLLC
Entity type:Organization
Organization Name:HEMA TALASILA MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HEMA
Authorized Official - Middle Name:N
Authorized Official - Last Name:TALASILA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-799-5440
Mailing Address - Street 1:2578 MCLEOD DR N
Mailing Address - Street 2:STE 1
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2859
Mailing Address - Country:US
Mailing Address - Phone:989-799-5440
Mailing Address - Fax:989-799-5651
Practice Address - Street 1:2578 MCLEOD DR N
Practice Address - Street 2:STE 1
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2859
Practice Address - Country:US
Practice Address - Phone:989-799-5440
Practice Address - Fax:989-799-5651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010823281041C0700X
MI68010212641041C0700X
MI68010811051041C0700X
MI4301406352174400000X
2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3184350Medicaid
MI284151000OtherMAGELLAN
MIP20Z901050OtherBCBSM