Provider Demographics
NPI:1043665987
Name:MILES, TAYLOR MORGAN (MD)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MORGAN
Last Name:MILES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 W REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:IL
Mailing Address - Zip Code:61764-9774
Mailing Address - Country:US
Mailing Address - Phone:815-842-2828
Mailing Address - Fax:815-842-4912
Practice Address - Street 1:2500 W REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-9774
Practice Address - Country:US
Practice Address - Phone:815-842-2828
Practice Address - Fax:815-842-4912
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD11903207Q00000X, 207Q00000X
GUM-2317207Q00000X
GUEMTL-2022-009207Q00000X
MTMED-PHYS-LIC-91574207Q00000X
IL036153522207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine