Provider Demographics
NPI:1104816511
Name:TAUNT, CHARLES J JR (DO)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:TAUNT
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2815 S PENNSYLVANIA AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-3496
Mailing Address - Country:US
Mailing Address - Phone:517-267-0200
Mailing Address - Fax:517-267-1877
Practice Address - Street 1:2815 S PENNSYLVANIA AVE
Practice Address - Street 2:STE 204
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-3496
Practice Address - Country:US
Practice Address - Phone:517-267-0200
Practice Address - Fax:517-267-1877
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MICT014232207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2053311925OtherBLUES
MI4947523Medicaid
7424589OtherAETNA
5331119OtherBCN
MI200000006523OtherPHP
MIBT7683558OtherDEA
7518550001Medicare NSC
MI2053311925OtherBLUES
MIBT7683558OtherDEA