Healthcare Provider Details

I. General information

NPI: 1710058680
Provider Name (Legal Business Name): AMY J DAROS DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5065 MILLER RD
FLINT MI
48507-1037
US

IV. Provider business mailing address

PO BOX 887
GRAND BLANC MI
48480-0887
US

V. Phone/Fax

Practice location:
  • Phone: 810-230-0338
  • Fax: 810-230-0595
Mailing address:
  • Phone: 810-230-0338
  • Fax: 810-230-0595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number5101012998
License Number StateMI

VIII. Authorized Official

Name: AMY J DAROS
Title or Position: OWNER PRESIDENT
Credential: DO
Phone: 810-230-0338