Basic Information
| Provider Information | |||||||||
| NPI: | 1992365720 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEGIULIO | ||||||||
| FirstName: | TAYLOR | ||||||||
| MiddleName: | JONES | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JONES | ||||||||
| OtherFirstName: | TAYLOR | ||||||||
| OtherMiddleName: | CLAIRE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3535 W 13 MILE RD STE 329 | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480736770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485510845 | ||||||||
| FaxNumber: | 2485513130 | ||||||||
| Practice Location | |||||||||
| Address1: | 3535 W 13 MILE RD STE 329 | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480736770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485510845 | ||||||||
| FaxNumber: | 2485513130 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2019 | ||||||||
| LastUpdateDate: | 06/19/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 4351044553 | MI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.