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General NPI Number Information
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NPI Number | 1679465959
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Entity Type | Individual
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Provider Name | TAYLOR LOCKRIDGE
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Gender |
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Dates
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Enumeration Date | 07/19/2025
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 8633 SOUTHFIELD FWY
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City | DETROIT
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State | MI
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Zip | 48228-1975
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Country | US
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Telephone | 313-804-8635
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Fax |
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Provider Business Mailing Address
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Address Line | 22430 GRATIOT AVE UNIT 227
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City | EASTPOINTE
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State | MI
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Zip | 48021-7011
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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 |
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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