MEDICARE: MR. KIM MICHAEL TAYLOR MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	I 0000350	OH

General Provider Information

NPI Number	:	1497854277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KIM MICHAEL TAYLOR MSW

Provider Business Mailing Address
First Line	:	8296 BRIDLE RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45244-2530
Country	:	US
Telephone Number	:	513-321-0500
Fax Number	:	513-474-0807

Provider Business Practice Location Address
First Line	:	1015 DELTA AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-3103
Country	:	US
Telephone Number	:	513-321-0500
Fax Number	:	513-474-0807

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	07/08/2007

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