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NPI Code Detail

MEDICARE: MR. KEVIN K TAYLOR P.A.-C.

MEDICARE: MR. KEVIN K TAYLOR P.A.-C.
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
1363A00000XPhysician Assistant5601001125MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15601001125OTHERMISTATE ID

General Provider Information

NPI Number : 1518042654
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEVIN K TAYLOR P.A.-C.
Provider Business Mailing Address
First Line : 2424 SPRING ARBOR RD
Second Line :
City : JACKSON
State : MI
Zip : 49203-2748
Country : US
Telephone Number : 517-787-0500
Fax Number : 517-787-1555
Provider Business Practice Location Address
First Line : 2424 SPRING ARBOR RD
Second Line :
City : JACKSON
State : MI
Zip : 49203-2748
Country : US
Telephone Number : 517-787-0500
Fax Number : 517-787-1555
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2006
Last Update Date : 07/08/2007

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