Individual
CAN TALUG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
611 E DOUGLAS RD STE 309, MISHAWAKA, IN 46545-1467
(574) 948-5390
Mailing address
707 CEDAR ST STE 405, SOUTH BEND, IN 46617-2059
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
01071991A
IN
208800000X
Urology Physician
22349
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201126590
—
IN
Enumeration date
06/15/2007
Last updated
11/16/2023
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