Provider Demographics
NPI:1851940167
Name:TOBAR, DARBY KATHERINE (PA-C)
Entity Type:Individual
Prefix:
First Name:DARBY
Middle Name:KATHERINE
Last Name:TOBAR
Suffix:
Gender:F
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 1:28624 OAKMONT CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-2995
Mailing Address - Country:US
Mailing Address - Phone:248-755-6520
Mailing Address - Fax:
Practice Address - Street 1:17800 NEWBURGH RD STE 103
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2794
Practice Address - Country:US
Practice Address - Phone:734-464-9540
Practice Address - Fax:734-464-0438
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601009512363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601009512OtherPHYSICIAN ASSISTANT LICENSE