Healthcare Provider Details

I. General information

NPI: 1801270392
Provider Name (Legal Business Name): CHRISTOPHER C TAYLOR M..D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 E RACINE ST
JANESVILLE WI
53546-2343
US

IV. Provider business mailing address

3200 E RACINE ST
JANESVILLE WI
53546-2343
US

V. Phone/Fax

Practice location:
  • Phone: 608-371-8000
  • Fax: 608-371-8938
Mailing address:
  • Phone: 608-371-8000
  • Fax: 608-371-8938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01077779A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number82361-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: