Healthcare Provider Details

I. General information

NPI: 1003183435
Provider Name (Legal Business Name): DONALD M TAYLOR MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 W BIG BEAVER RD
TROY MI
48084-3542
US

IV. Provider business mailing address

1629 W BIG BEAVER RD
TROY MI
48084-3542
US

V. Phone/Fax

Practice location:
  • Phone: 248-649-2266
  • Fax: 248-649-7246
Mailing address:
  • Phone: 248-649-2266
  • Fax: 248-649-7246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number30829
License Number StateMI

VIII. Authorized Official

Name: DR. DONALD M TAYLOR
Title or Position: PRESIDENT
Credential: MD
Phone: 248-649-2266