Healthcare Provider Details

I. General information

NPI: 1194712471
Provider Name (Legal Business Name): DANIEL ROBERT DOMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 11/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E CUMMINS ST
TECUMSEH MI
49286-2070
US

IV. Provider business mailing address

1 SEAGATE STE 800
TOLEDO OH
43604-1558
US

V. Phone/Fax

Practice location:
  • Phone: 174-243-0705
  • Fax: 517-423-2786
Mailing address:
  • Phone: 517-424-3070
  • Fax: 517-423-2786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDD008869
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: