Provider Demographics
NPI:1447251475
Name:TAYLOR, DAVID T (DPM)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:T
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 HAMPDEN RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503
Mailing Address - Country:US
Mailing Address - Phone:810-257-0508
Mailing Address - Fax:
Practice Address - Street 1:1303 S LINDEN RD
Practice Address - Street 2:SUITE D
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532
Practice Address - Country:US
Practice Address - Phone:810-230-0177
Practice Address - Fax:810-230-8090
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDT002073213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI381898080OtherFEDERAL
MI4445817Medicaid
MI381898080OtherFEDERAL
MIU92220Medicare UPIN