Provider Demographics
NPI:1902029713
Name:E J DAROS DO PC
Entity Type:Organization
Organization Name:E J DAROS DO PC
Other - Org Name:FAMILY DOCS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVTISHIOS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DAROS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-603-0990
Mailing Address - Street 1:8275 HOLLY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2442
Mailing Address - Country:US
Mailing Address - Phone:810-603-0990
Mailing Address - Fax:810-603-1678
Practice Address - Street 1:8275 HOLLY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2442
Practice Address - Country:US
Practice Address - Phone:810-603-0990
Practice Address - Fax:810-603-1678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIED007048207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1003800350OtherNPI INDIVIDUAL
MI4614320Medicaid
MIED007048OtherSTATE LICENSE NUMBER
MI080B511230OtherBCBSM
MIDM076048OtherSTATE LICENSE NUMBER
MI$$$$$$$$$OtherSSN
MIAD013144OtherSTATE LICENSE NUMBER
MI1316944333OtherNPI INDIVIDUAL
MI1841284437OtherNPI INDIVIDUAL
MI$$$$$$$$$OtherSSN
MI2095522Medicaid
MI4613396Medicaid
MI$$$$$$$$$OtherSSN
MI4614320Medicaid
MI0N16060002Medicare ID - Type Unspecified
MI080B511230OtherBCBSM
MII00810Medicare UPIN