Basic Information
| Provider Information | |||||||||
| NPI: | 1447226154 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20525 CENTER RIDGE RD | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | ROCKY RIVER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441163437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408955056 | ||||||||
| FaxNumber: | 4403332935 | ||||||||
| Practice Location | |||||||||
| Address1: | 18101 LORAIN AVE | ||||||||
| Address2: | DEPARTMENT OF SURGERY | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441115612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164767155 | ||||||||
| FaxNumber: | 2164767883 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2006 | ||||||||
| LastUpdateDate: | 01/10/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 35086752T | OH | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | CA4511 | 01 | RR MEDICARE GROUP | OTHER | 129595 | 01 | KAISER | OTHER | P00301523 | 01 | RR MEDICARE INDIVIDUAL | OTHER | 11569145 | 01 | CAQH | OTHER | 1780634279 | 01 | GROUP NPI | OTHER | 3610861 | 01 | GROUP ASC MEDICARE | OTHER | 9273172 | 01 | GROUP MEDICARE | OTHER | 0119204 | 01 | GROUP MEDICAID | OTHER | D368301 | 01 | GROUP IND DIAGNOSTICS MED | OTHER |