Provider Demographics
NPI:1710058680
Name:AMY J DAROS DO PC
Entity Type:Organization
Organization Name:AMY J DAROS DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAROS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-230-0338
Mailing Address - Street 1:PO BOX 887
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48480-0887
Mailing Address - Country:US
Mailing Address - Phone:810-230-0338
Mailing Address - Fax:810-230-0595
Practice Address - Street 1:5065 MILLER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1037
Practice Address - Country:US
Practice Address - Phone:810-230-0338
Practice Address - Fax:810-230-0595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012998207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4250600Medicaid
MI0856311114OtherBLUE CROSS BLUE SHIELD
MI0856311114OtherBLUE CROSS BLUE SHIELD
MI4250600Medicaid