Basic Information
| Provider Information | |||||||||
| NPI: | 1720067655 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1230 E MAIN ST | ||||||||
| Address2: | PO BOX 8674 | ||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560015066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076251811 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1230 E MAIN ST | ||||||||
| Address2: | MANKATO CLINIC @ MAIN STREET | ||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560015066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076251811 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 07/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 28590 | MN | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 410849339 56001 C028 | 01 | CHAMPUS | OTHER | 337385100 | 05 | MN | MEDICAID | 160025572 | 01 | RR MEDICARE | OTHER | 1652118 | 01 | AMERICAS PPO MN | OTHER | 115554 | 01 | UCARE MN | OTHER | 928549 | 05 | IA | MEDICAID | HP25870 | 01 | HEALTH PARTNERS MN | OTHER | 0702740 | 01 | MEDICA MN | OTHER | NA2951023863 | 01 | PREFERRED ONE MN | OTHER | 49433TA | 01 | BCBS MN | OTHER |