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General NPI Number Information
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NPI Number | 1417304775
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Entity Type | Organization
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Legal Business Name | TAYLOR PEDIATRICS PC
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Dates
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Enumeration Date | 05/17/2016
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Last Update Date | 06/10/2016
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Provider Practice Location Address
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Address Line | 23611 GODDARD RD STE A
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City | TAYLOR
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State | MI
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Zip | 48180-4046
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Country | US
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Telephone | 606-791-1291
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Fax |
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Provider Business Mailing Address
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Address Line | 23611 GODDARD RD STE A
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City | TAYLOR
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State | MI
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Zip | 48180-4046
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Country | US
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Telephone | 606-791-1291
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MHD- HUSSAM DIARBAKRLI
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Credential | MD
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Telephone | 606-791-1291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 4301056799
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License Number State | MI
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