MEDICARE: DAROS ALTERNATIVE, PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1376053801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAROS ALTERNATIVE, PLC

Provider Business Mailing Address
First Line	:	8275 HOLLY RD STE 1
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-2442
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8275 HOLLY RD STE 1
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-2442
Country	:	US
Telephone Number	:	810-240-9254
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANTONY DAROS
Credential	:	D.O.
Telephone Number	:	810-240-9254

Provider Enumeration Date	:	10/11/2017
Last Update Date	:	10/11/2017

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