Provider Demographics
NPI:1023102381
Name:TAYLOR, MICHAEL KANE (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KANE
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 180
Mailing Address - Street 2:
Mailing Address - City:CAPSHAW
Mailing Address - State:AL
Mailing Address - Zip Code:35742
Mailing Address - Country:US
Mailing Address - Phone:256-233-4886
Mailing Address - Fax:256-233-4522
Practice Address - Street 1:15024 E LIMESTONE RD
Practice Address - Street 2:STE F
Practice Address - City:HARVEST
Practice Address - State:AL
Practice Address - Zip Code:35749
Practice Address - Country:US
Practice Address - Phone:256-233-4886
Practice Address - Fax:256-233-4522
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25516207Q00000X
TN207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51001271OtherBCBS
H64199Medicare UPIN