Provider Demographics
NPI:1801055983
Name:TAYLOR, PRENTISS B (MD)
Entity type:Individual
Prefix:
First Name:PRENTISS
Middle Name:B
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:29373 NETWORK PL STE 202
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:847-390-4757
Practice Address - Street 1:9831 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1740
Practice Address - Country:US
Practice Address - Phone:773-445-3500
Practice Address - Fax:773-445-0575
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2022-12-16
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Provider Licenses
StateLicense IDTaxonomies
MS24029207R00000X
CAG86930207R00000X
LA301696207R00000X
ARE-12633207R00000X
TN51482207R00000X
MN59992207R00000X
IN01059715A207R00000X
AZ37632207R00000X
NE28097207R00000X
KS04-37501207R00000X
UT9123410-1205207R00000X
IAMD-42030207R00000X
MO2014029944207R00000X
TXQ3298207R00000X
IL036-058964207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036058964OtherLICENSE NUMBER