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NPI Code Detail

MEDICARE: TAYLOR SMITH RD

MEDICARE:   TAYLOR  SMITH  RD
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
1133V00000XRegistered Dietitian37003491AIN

General Provider Information

NPI Number : 1710689229
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAYLOR SMITH RD
Provider Business Mailing Address
First Line : 904 SOUTH ST
Second Line :
City : LAFAYETTE
State : IN
Zip : 47901-1416
Country : US
Telephone Number : 765-630-7222
Fax Number :
Provider Business Practice Location Address
First Line : 90 EXECUTIVE DR STE C
Second Line :
City : CARMEL
State : IN
Zip : 46032-2612
Country : US
Telephone Number : 317-740-1970
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2023
Last Update Date : 03/20/2023

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Directions to “ TAYLOR SMITH RD” Practice Location

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