Provider Demographics
NPI:1851430219
Name:FALLAT, DAVID MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:FALLAT
Suffix:
Gender:
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:12087 SHERATON LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-1611
Mailing Address - Country:US
Mailing Address - Phone:513-851-8790
Mailing Address - Fax:513-851-0434
Practice Address - Street 1:1225 W 190TH ST STE 280
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4305
Practice Address - Country:US
Practice Address - Phone:877-515-8113
Practice Address - Fax:877-538-2102
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH350639092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry