Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | CT014232 | MI |
NPI | 1104816511 |
---|---|
Provider Name | Charles J Taunt JR. |
First Address | Lansing, MI 48910-3496 |
Second Address | Lansing, MI 48910-3496 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 03/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200000006523 | PHP (01) | MI |
2053311925 | BLUES (01) | MI |
4947523 | (05) | MI |
5331119 | BCN (01) | |
7424589 | AETNA (01) | |
BT7683558 | DEA (01) | MI |
I35108 | (02) |