Provider Demographics
NPI:1760679203
Name:MULKEY, TAYLOR BENOIT (MD)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:BENOIT
Last Name:MULKEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:TAYLOR
Other - Last Name:BENOIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:612 SEACOAST PKWY
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8247
Practice Address - Country:US
Practice Address - Phone:843-881-4440
Practice Address - Fax:843-884-8540
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30772207N00000X, 207ND0101X
FLME144280207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3334452OtherUHC
KY5129024OtherCIGNA
712736OtherBCBS
FLMH439OtherMEDICARE
FLNWPVDOtherBCBS
KY9722728OtherAETNA
KYP00940992OtherMEDICARE RR