Provider Demographics
NPI:1518540517
Name:TAYLOR, SERENA MIKHAL (MD)
Entity Type:Individual
Prefix:DR
First Name:SERENA
Middle Name:MIKHAL
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:MIKHAL
Other - Middle Name:SERENA
Other - Last Name:FREIMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1415 N POINTE CT
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47725-8313
Mailing Address - Country:US
Mailing Address - Phone:858-220-4614
Mailing Address - Fax:
Practice Address - Street 1:1501 N CAMPBELL AVE STE 8401
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-0001
Practice Address - Country:US
Practice Address - Phone:520-626-9245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR78678207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery