Provider Demographics
NPI:1316944333
Name:DAROS, EVTISHIOS JAMES (DO)
Entity type:Individual
Prefix:
First Name:EVTISHIOS
Middle Name:JAMES
Last Name:DAROS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8275 HOLLY RD
Mailing Address - Street 2:SUITE1
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2442
Mailing Address - Country:US
Mailing Address - Phone:810-603-0990
Mailing Address - Fax:
Practice Address - Street 1:8275 HOLLY RD
Practice Address - Street 2:SUITE1
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2442
Practice Address - Country:US
Practice Address - Phone:810-603-0990
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIED007048207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2095522Medicaid
MI5253833OtherBCBS
MI25238337Medicare ID - Type UnspecifiedMEDICARE
MI2095522Medicaid