MEDICARE: TAYLOR FREDERICK

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	363LF0000X	Family Nurse Practitioner	4704320839	MI

General Provider Information

NPI Number	:	1861158115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR FREDERICK

Provider Business Mailing Address
First Line	:	26346 GIBRALTAR RD
Second Line	:
City	:	FLAT ROCK
State	:	MI
Zip	:	48134-1522
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	26346 GIBRALTAR RD
Second Line	:
City	:	FLAT ROCK
State	:	MI
Zip	:	48134-1522
Country	:	US
Telephone Number	:	734-535-8977
Fax Number	:

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

Provider Enumeration Date	:	11/11/2021
Last Update Date	:	12/07/2021

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Directions to “ TAYLOR FREDERICK ” Practice Location

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