Provider Demographics
NPI:1134789340
Name:TESORO-FILA, TAYLOR LILAMIA (DPM)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:LILAMIA
Last Name:TESORO-FILA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:LILAMIA
Other - Last Name:TESORO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5400 MACKINAW RD STE 2100
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-9532
Mailing Address - Country:US
Mailing Address - Phone:989-790-4662
Mailing Address - Fax:
Practice Address - Street 1:5400 MACKINAW RD STE 2100
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-9532
Practice Address - Country:US
Practice Address - Phone:989-790-4662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5951001228213E00000X
MI5901400442213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist