Provider Demographics
NPI:1093236192
Name:BARATONO, JACLYN TAYLOR (DO)
Entity type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:TAYLOR
Last Name:BARATONO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:22731 NEWMAN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2023
Mailing Address - Country:US
Mailing Address - Phone:313-982-0200
Mailing Address - Fax:
Practice Address - Street 1:22731 NEWMAN ST STE 200
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2023
Practice Address - Country:US
Practice Address - Phone:313-982-0200
Practice Address - Fax:313-982-0500
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101023627207V00000X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic SurgeryGroup - Single Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology