Healthcare Provider Details

I. General information

NPI: 1518238104
Provider Name (Legal Business Name): TAYLOR COMPREHENSIVE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 DEXTER AVE
DETROIT MI
48206-1816
US

IV. Provider business mailing address

7700 TELEGRAPH RD
TAYLOR MI
48180-2236
US

V. Phone/Fax

Practice location:
  • Phone: 313-894-7881
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301045243
License Number StateMI

VIII. Authorized Official

Name: CARL FOWLER
Title or Position: CEO
Credential: M.D.
Phone: 313-299-0467