Provider Demographics
NPI:1790877025
Name:TAYLOR, TERRIE ELLEN (DO)
Entity Type:Individual
Prefix:DR
First Name:TERRIE
Middle Name:ELLEN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:B305 W FEE HALL
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-1315
Mailing Address - Country:US
Mailing Address - Phone:517-353-3211
Mailing Address - Fax:517-432-1062
Practice Address - Street 1:B305 W FEE HALL
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-1315
Practice Address - Country:US
Practice Address - Phone:517-353-8975
Practice Address - Fax:517-432-1062
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2008-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101008375207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA00000Medicare UPIN