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General NPI Number Information
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NPI Number | 1386974335
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Entity Type | Organization
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Legal Business Name | TAYLOR DRUG REHAB CENTER PC
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Dates
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Enumeration Date | 01/13/2010
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Last Update Date | 10/08/2010
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Provider Practice Location Address
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Address Line | 7700 TELEGRAPH RD
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City | TAYLOR
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State | MI
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Zip | 48180-2236
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Country | US
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Telephone | 313-299-0467
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Fax |
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Provider Business Mailing Address
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Address Line | 7700 TELEGRAPH RD
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City | TAYLOR
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State | MI
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Zip | 48180-2236
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. CARL FOWLER
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Credential | M.D.
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Telephone | 313-299-0467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 4301045243
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301045243
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License Number State | MI
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