Healthcare Provider Details

I. General information

NPI: 1861047698
Provider Name (Legal Business Name): TAYLOR POZAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18100 OAKWOOD BLVD STE 205
DEARBORN MI
48124-4085
US

IV. Provider business mailing address

26901 BEAUMONT BLVD
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 313-438-7880
  • Fax: 313-438-7882
Mailing address:
  • Phone: 248-577-3313
  • Fax: 248-577-3302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601009057
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601009057
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: