1487800959 NPI number — DARCIE JEAN DOHNAL MD

Table of content: DARCIE JEAN DOHNAL MD (NPI 1487800959)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487800959 NPI number — DARCIE JEAN DOHNAL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOHNAL
Provider First Name:
DARCIE
Provider Middle Name:
JEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHARAPOVA
Provider Other First Name:
DARCIE
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487800959
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14734 PARK AVENUE BLDG A
Provider Second Line Business Mailing Address:
CHARLEVOIX PRIMARY CARE
Provider Business Mailing Address City Name:
CHARLEVOIX
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49720-1927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-547-6554
Provider Business Mailing Address Fax Number:
231-392-7332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14734 PARK AVENUE BLDG A
Provider Second Line Business Practice Location Address:
CHARLEVOIX PRIMARY CARE
Provider Business Practice Location Address City Name:
CHARLEVOIX
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49720-1927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-547-6554
Provider Business Practice Location Address Fax Number:
231-392-7332
Provider Enumeration Date:
08/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  4301095917 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0260179 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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