Provider Demographics
NPI:1447912415
Name:CONSIGLIO, TAYLOR R
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:R
Last Name:CONSIGLIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45320 NOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-3886
Mailing Address - Country:US
Mailing Address - Phone:586-719-8666
Mailing Address - Fax:
Practice Address - Street 1:18414 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48042-6217
Practice Address - Country:US
Practice Address - Phone:586-719-8666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant