Provider Demographics
NPI:1730932849
Name:TAYLOR, MARK JOSEPH
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JOSEPH
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 596364
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-6364
Mailing Address - Country:US
Mailing Address - Phone:586-549-7221
Mailing Address - Fax:
Practice Address - Street 1:7799 COMSTOCK RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MI
Practice Address - Zip Code:48006-1530
Practice Address - Country:US
Practice Address - Phone:586-549-7221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider