Provider Demographics
NPI:1144435009
Name:DAOUD SURGERY & FAMILY MEDICINE PC
Entity type:Organization
Organization Name:DAOUD SURGERY & FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-278-2675
Mailing Address - Street 1:356 E CHICAGO ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-2057
Mailing Address - Country:US
Mailing Address - Phone:517-278-3675
Mailing Address - Fax:517-279-0049
Practice Address - Street 1:356 E CHICAGO ST
Practice Address - Street 2:SUITE A
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-2057
Practice Address - Country:US
Practice Address - Phone:517-278-3675
Practice Address - Fax:517-279-0049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208600000X
MICD51012553207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4528160Medicaid
MI4528150Medicaid
MI4528160Medicaid
P58560002Medicare PIN
P58560001Medicare PIN