Basic Information
| Provider Information | |||||||||
| NPI: | 1134780794 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARLAND | ||||||||
| FirstName: | TAYLOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1254 LEANNE CT | ||||||||
| Address2: | |||||||||
| City: | KENNEDALE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760606036 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 47601 GRAND RIVER AVE | ||||||||
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| City: | NOVI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483741233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484654100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2019 | ||||||||
| LastUpdateDate: | 05/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 5601009837 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.