Provider Demographics
NPI:1598397333
Name:BELDING, DARYL DUANE (PA-C)
Entity Type:Individual
Prefix:
First Name:DARYL
Middle Name:DUANE
Last Name:BELDING
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-1176
Mailing Address - Country:US
Mailing Address - Phone:248-673-0500
Mailing Address - Fax:248-673-6077
Practice Address - Street 1:3740 BRIARBROOKE LN
Practice Address - Street 2:
Practice Address - City:OAKLAND TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48306-4746
Practice Address - Country:US
Practice Address - Phone:248-736-0199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI5601010229363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty