=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891725818
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY PODIATRY GROUP, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2006
-----------------------------------------------------
Last Update Date | 03/10/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1303 S LINDEN RD STE D
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48532-3442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-230-0177
-----------------------------------------------------
Fax | 810-230-8090
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1303 S LINDEN RD STE D
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48532-3442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-230-0177
-----------------------------------------------------
Fax | 810-230-8090
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DAVID T TAYLOR
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 810-230-0177
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 5901002073
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------