MEDICARE: MICHAEL GEORGE TAYLOR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	405365	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154363240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL GEORGE TAYLOR MD

Provider Business Mailing Address
First Line	:	24535 JEFFERSON AVE
Second Line	:	STE C
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48080-2898
Country	:	US
Telephone Number	:	586-443-5400
Fax Number	:	586-443-5403

Provider Business Practice Location Address
First Line	:	22646 NINE MILE ROAD
Second Line	:	STE C
City	:	ST CLAIR SHORES
State	:	MI
Zip	:	48080-1951
Country	:	US
Telephone Number	:	586-443-5400
Fax Number	:	586-443-5403

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	09/12/2016

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