Healthcare Provider Details

I. General information

NPI: 1053422683
Provider Name (Legal Business Name): DONALD PROUX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1332 PROSPECT AVE
CARO MI
48723-9288
US

IV. Provider business mailing address

323 N STATE ST PO BOX 239
CARO MI
48723-1537
US

V. Phone/Fax

Practice location:
  • Phone: 989-673-6191
  • Fax: 989-672-3053
Mailing address:
  • Phone: 989-673-6191
  • Fax: 989-673-1596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301026400
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: