Provider Demographics
NPI:1952756066
Name:DUSO, DARREN (HIS)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:
Last Name:DUSO
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 N CLIPPERT ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-4733
Mailing Address - Country:US
Mailing Address - Phone:517-333-3083
Mailing Address - Fax:517-333-1519
Practice Address - Street 1:724 N CLIPPERT ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4733
Practice Address - Country:US
Practice Address - Phone:517-333-3083
Practice Address - Fax:517-333-1519
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501004857237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist