Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 2301008033 | MI |
NPI | 1376563015 |
---|---|
Provider Name | Dr. Darren Allen Donathan |
First Address | Riverview, MI 48193-6630 |
Second Address | Riverview, MI 48193-6630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4673859 | (05) | MI |
99439 | (02) | MI |