Provider Demographics
NPI:1003800350
Name:DAROS, ANTONY JAMES (DO)
Entity Type:Individual
Prefix:DR
First Name:ANTONY
Middle Name:JAMES
Last Name:DAROS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8275 HOLLY RD
Mailing Address - Street 2:STE 1
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2442
Mailing Address - Country:US
Mailing Address - Phone:810-603-0990
Mailing Address - Fax:810-603-1678
Practice Address - Street 1:8275 HOLLY RD
Practice Address - Street 2:STE 1
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2442
Practice Address - Country:US
Practice Address - Phone:810-603-0990
Practice Address - Fax:810-603-1678
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101013144207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4613396Medicaid
MI4613396Medicaid
MI0N16060001Medicare ID - Type Unspecified