Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 4351046058 | MI |
NPI | 1003432212 |
---|---|
Provider Name | Dr. Soraya Darwood |
First Address | Grand Blanc, MI 48439-8065 |
Second Address | Grand Blanc, MI 48439-8065 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2020 |
Last Update Date | 23/06/2020 |