Provider Demographics
NPI:1588739395
Name:CHARLES J TAUNT JR DO PC
Entity type:Organization
Organization Name:CHARLES J TAUNT JR DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:TAUNT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:517-267-0200
Mailing Address - Street 1:2815 S PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910
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:SUITE 204
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910
Practice Address - Country:US
Practice Address - Phone:517-267-0200
Practice Address - Fax:517-267-1877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICTO14232207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP06750002Medicare ID - Type Unspecified
I35108Medicare UPIN