Healthcare Provider Details

I. General information

NPI: 1588739395
Provider Name (Legal Business Name): CHARLES J TAUNT JR DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 S PENNSYLVANIA AVE SUITE 204
LANSING MI
48910
US

IV. Provider business mailing address

2815 S PENNSYLVANIA AVE SUITE 204
LANSING MI
48910
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 NumberCTO14232
License Number StateMI

VIII. Authorized Official

Name: CHARLES J TAUNT JR.
Title or Position: PRESIDENT
Credential: DO
Phone: 517-267-0200