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General NPI Number Information
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NPI Number | 1528099884
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Entity Type | Individual
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Provider Name | BONNIE L. TAYLOR D.O.
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Gender | Female
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 4600 BRETON RD SE SUITE 102
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City | KENTWOOD
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State | MI
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Zip | 49508-5262
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Country | US
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Telephone | 616-391-9970
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Fax | 616-391-9707
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Provider Business Mailing Address
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Address Line | 100 MICHIGAN ST NE MC 845
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-2560
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Country | US
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Telephone | 616-391-9700
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Fax | 616-391-9707
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101010156
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License Number State | MI
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