Provider Demographics
NPI:1609490051
Name:CHMURA, TAYLOR (MS, CGC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:CHMURA
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 W GRAND BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3141
Mailing Address - Country:US
Mailing Address - Phone:313-916-1439
Mailing Address - Fax:313-916-1730
Practice Address - Street 1:3031 W GRAND BLVD STE 700
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3141
Practice Address - Country:US
Practice Address - Phone:313-916-1439
Practice Address - Fax:313-916-1730
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7201000012170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS