Provider Demographics
NPI:1043375173
Name:TAI, PAUL LING (DPM)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:LING
Last Name:TAI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9224 PELHAM ROAD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-3832
Mailing Address - Country:US
Mailing Address - Phone:313-333-2356
Mailing Address - Fax:
Practice Address - Street 1:9224 PELHAM RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3832
Practice Address - Country:US
Practice Address - Phone:313-292-8400
Practice Address - Fax:313-292-8430
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPT0000663213E00000X
MIPT000663213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1891228Medicaid
MI5825176Medicare ID - Type Unspecified
MI1891228Medicaid