Provider Demographics
NPI:1568898666
Name:TAYLOR, TIMOTHY C (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:C
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1174 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1497
Mailing Address - Country:US
Mailing Address - Phone:269-781-9867
Mailing Address - Fax:269-781-9126
Practice Address - Street 1:1174 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1497
Practice Address - Country:US
Practice Address - Phone:269-781-9867
Practice Address - Fax:269-781-9126
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601006752363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant