Provider Demographics
NPI:1720196967
Name:DARLENE F DALY DO PC
Entity Type:Organization
Organization Name:DARLENE F DALY DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:F
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-678-8807
Mailing Address - Street 1:809 W DRYDEN RD
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:MI
Mailing Address - Zip Code:48455-8961
Mailing Address - Country:US
Mailing Address - Phone:810-678-8807
Mailing Address - Fax:810-678-4088
Practice Address - Street 1:809 W DRYDEN RD
Practice Address - Street 2:
Practice Address - City:METAMORA
Practice Address - State:MI
Practice Address - Zip Code:48455-8961
Practice Address - Country:US
Practice Address - Phone:810-678-8807
Practice Address - Fax:810-678-4088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114177430Medicaid
0M94010Medicare PIN