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General NPI Number Information
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NPI Number | 1568920601
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Entity Type | Individual
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Provider Name | GREGORY JON TAYCHER
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Gender | Male
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Dates
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Enumeration Date | 03/07/2019
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Last Update Date | 03/08/2019
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Provider Practice Location Address
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Address Line | 9701 W HIGGINS RD # 270
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City | ROSEMONT
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State | IL
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Zip | 60018-4703
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Country | US
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Telephone | 815-654-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 311 W NORTH WATER ST
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City | NEENAH
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State | WI
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Zip | 54956-2647
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Country | US
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Telephone | 920-268-9675
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085006962
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License Number State | IL
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