Provider Demographics
NPI:1568779940
Name:TAYLOR, DONALD ALEX (PA)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:ALEX
Last Name:TAYLOR
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Gender:M
Credentials:PA
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Mailing Address - Street 1:1200 E MICHIGAN AVE
Mailing Address - Street 2:SUITE 530
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-1800
Mailing Address - Country:US
Mailing Address - Phone:517-364-5880
Mailing Address - Fax:517-364-5887
Practice Address - Street 1:1200 E MICHIGAN AVE
Practice Address - Street 2:SUITE 530
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1800
Practice Address - Country:US
Practice Address - Phone:517-364-5880
Practice Address - Fax:517-364-5887
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2011-09-16
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Provider Licenses
StateLicense IDTaxonomies
MI5601005856363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M74460402Medicare PIN
MI0N38550111Medicare PIN