Individual
SHANNON LEIGH TAUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
39901 TRADITIONS DR, SUITE 240, NORTHVILLE, MI 48168-9493
(248) 305-4400
Mailing address
3621 S STATE ST, ANN ARBOR, MI 48108-1633
(734) 647-5299
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301104680
MI
208000000X
Pediatrics Physician
67156-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265845770
—
WI
Enumeration date
06/03/2014
Last updated
02/12/2020
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