Provider Demographics
NPI:1427006519
Name:PARKER, DARYL TYRONE (MD)
Entity Type:Individual
Prefix:DR
First Name:DARYL
Middle Name:TYRONE
Last Name:PARKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:MI
Mailing Address - Zip Code:48160-1213
Mailing Address - Country:US
Mailing Address - Phone:734-439-1491
Mailing Address - Fax:734-439-7150
Practice Address - Street 1:55 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:MI
Practice Address - Zip Code:48160-1213
Practice Address - Country:US
Practice Address - Phone:734-439-1491
Practice Address - Fax:734-439-7150
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301050950207R00000X
OH35.080767207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383327034OtherTAX ID
MI10-4357115Medicaid
MI10-4357115Medicaid
MI383327034OtherTAX ID