Provider Demographics
NPI:1114502374
Name:TAYLOR, INGA INEZ
Entity type:Individual
Prefix:MS
First Name:INGA
Middle Name:INEZ
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:INGA
Other - Middle Name:INEZ
Other - Last Name:O'NEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18099 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-2625
Mailing Address - Country:US
Mailing Address - Phone:810-964-4477
Mailing Address - Fax:
Practice Address - Street 1:19401 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2277
Practice Address - Country:US
Practice Address - Phone:734-785-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator