Active NPI
Taylor J Jemilo, DMD
- Dentist
- Michigan City, IN
National Provider Identifier
1356077093
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12013943A
- Practice address
- 5240 Franklin St
Michigan City, IN 46360-7372 - Phone
- (219) 873-9000
- NPI assigned
- Jul 26, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019.033941 | IL | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | 12013943A | IN | Primary |
Addresses
Primary practice location
5240 Franklin St
Michigan City, IN 46360-7372
Mailing address
5240 Franklin St
Michigan City, IN 46360-7372
Phone (219) 873-9000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.033941 | IL | MD | Dentist |
| 12013943A | IN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1665964800000",
"number": "1356077093",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5240 FRANKLIN ST",
"city": "MICHIGAN CITY",
"state": "IN",
"postal_code": "463607372",
"telephone_number": "219-873-9000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5240 FRANKLIN ST",
"city": "MICHIGAN CITY",
"state": "IN",
"postal_code": "463607372",
"telephone_number": "219-873-9000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEMILO",
"first_name": "TAYLOR",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-07-26",
"last_updated": "2022-10-17",
"certification_date": "2022-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019.033941",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "12013943A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Michigan City, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.