Individual
MICHAEL P TAILLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
811 W MAIN ST, LEXINGTON, SC 29072-2507
(803) 358-6100
(803) 358-6105
Mailing address
PO BOX 6069, WEST COLUMBIA, SC 29171-6069
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
13613
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136132
—
SC
Enumeration date
09/07/2006
Last updated
11/11/2020
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