Healthcare Provider Details

I. General information

NPI: 1255160321
Provider Name (Legal Business Name): TAYLOR NEWHART PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18591 W 10 MILE RD
SOUTHFIELD MI
48075-2619
US

IV. Provider business mailing address

2950 W HAMLIN RD
ROCHESTER HILLS MI
48309
US

V. Phone/Fax

Practice location:
  • Phone: 248-621-9443
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: