Provider Demographics
NPI:1902070014
Name:MICHAEL G. TAYLOR,M.D.P.L.C.
Entity Type:Organization
Organization Name:MICHAEL G. TAYLOR,M.D.P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-443-5400
Mailing Address - Street 1:22646 E 9 MILE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1951
Mailing Address - Country:US
Mailing Address - Phone:586-443-5400
Mailing Address - Fax:586-443-5403
Practice Address - Street 1:22646 E 9 MILE RD
Practice Address - Street 2:STE. C
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1951
Practice Address - Country:US
Practice Address - Phone:586-443-5400
Practice Address - Fax:586-443-5403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI405365174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4134989Medicaid
F42118Medicare UPIN
OM86170Medicare PIN