Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 5101012998 | MI |
NPI | 1164443487 |
---|---|
Provider Name | Amy J Daros |
First Address | Grand Blanc, MI 48480-0887 |
Second Address | Flint, MI 48507-1037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 06/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4250600 | (05) | MI |
H19132 | (02) | MI |