Provider Demographics
NPI:1558734889
Name:SPERA, TAYLOR P (PA)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:P
Last Name:SPERA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:P
Other - Last Name:SPERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:4853 SOLUTIONS CTR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-4008
Mailing Address - Country:US
Mailing Address - Phone:260-407-8000
Mailing Address - Fax:260-407-8004
Practice Address - Street 1:395 WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-1425
Practice Address - Country:US
Practice Address - Phone:317-776-7199
Practice Address - Fax:317-776-7921
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000972951OtherBCBS
INM61063003Medicare PIN