Provider Demographics
NPI:1437130499
Name:DARGIS, DAVID JOHN (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:DARGIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1005 W GREEN ST STE 300
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1725
Practice Address - Country:US
Practice Address - Phone:269-948-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011358208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1825096OtherUNITED HEALTHCARE
MIP00651226OtherRR MEDICARE
MIDD011358OtherSTATE LICENSE #
MI0250300075OtherBCBS MI PROVID #
MI3346000Medicaid
MI17-31841OtherPHP PROVIDER #
MI18062OtherHEALTH PLAN OF MI
MI35227OtherCOMMUNITY CHOICE OF MI
MIP54781OtherBCN PROVIDER #
MI35227OtherCOMMUNITY CHOICE OF MI
MIZ36002014Medicare ID - Type Unspecified
MIP00651226OtherRR MEDICARE