Provider Demographics
NPI:1154375509
Name:TAL, DONNA JUDITH (MD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:JUDITH
Last Name:TAL
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Gender:F
Credentials:MD
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Mailing Address - Street 1:5333 MCAULEY DR
Mailing Address - Street 2:SUITE 6015
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1014
Mailing Address - Country:US
Mailing Address - Phone:734-434-7400
Mailing Address - Fax:734-434-7323
Practice Address - Street 1:5333 MCAULEY DR
Practice Address - Street 2:SUITE 6015
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1014
Practice Address - Country:US
Practice Address - Phone:734-434-7400
Practice Address - Fax:734-434-7323
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MI4301067712207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4455822-10Medicaid
MI1808130762OtherBLUE CROSS
MI128239OtherCARE CHOICE
MI1808130762OtherBLUE CROSS