Healthcare Provider Details

I. General information

NPI: 1033029939
Provider Name (Legal Business Name): TAYLOR MILROY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DES MOINES UNIVERSITY-PA PROGRAM 8025 GRAND AVENUE WEST
WEST DES MOINES IA
50266
US

IV. Provider business mailing address

4831 FOREST GROVE ST
LOVES PARK IL
61111-5824
US

V. Phone/Fax

Practice location:
  • Phone: 515-271-1569
  • Fax:
Mailing address:
  • Phone: 815-904-4450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: