Healthcare Provider Details

I. General information

NPI: 1104816511
Provider Name (Legal Business Name): CHARLES J TAUNT JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 S PENNSYLVANIA AVE STE 204
LANSING MI
48910-3496
US

IV. Provider business mailing address

2815 S PENNSYLVANIA AVE STE 204
LANSING MI
48910-3496
US

V. Phone/Fax

Practice location:
  • Phone: 517-267-0200
  • Fax: 517-267-1877
Mailing address:
  • Phone: 517-267-0200
  • Fax: 517-267-1877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberCT014232
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: