Provider Demographics
NPI:1447226154
Name:TAYLOR, MICHAEL D (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:20525 CENTER RIDGE RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3437
Mailing Address - Country:US
Mailing Address - Phone:440-895-5056
Mailing Address - Fax:440-333-2935
Practice Address - Street 1:18101 LORAIN AVE
Practice Address - Street 2:DEPARTMENT OF SURGERY
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5612
Practice Address - Country:US
Practice Address - Phone:216-476-7155
Practice Address - Fax:216-476-7883
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35086752T208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4511OtherRR MEDICARE GROUP
129595OtherKAISER
P00301523OtherRR MEDICARE INDIVIDUAL
11569145OtherCAQH
1780634279OtherGROUP NPI
3610861OtherGROUP ASC MEDICARE
9273172OtherGROUP MEDICARE
0119204OtherGROUP MEDICAID
D368301OtherGROUP IND DIAGNOSTICS MED
OH4169123Medicare PIN
1780634279OtherGROUP NPI