Basic Information
Provider Information
NPI: 1790006971
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KING
FirstName: DARREN
MiddleName: PATRICK
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3621 S STATE ST
Address2:  
City: ANN ARBOR
State: MI
PostalCode: 481081633
CountryCode: US
TelephoneNumber: 7346475299
FaxNumber:  
Practice Location
Address1: 1500 EAST MEDICAL CENTER DR
Address2: 7TH FLOOR C.S. MOTT CHILDREN'S HOSPITAL RECP 'B'
City: ANN ARBOR
State: MI
PostalCode: 481094257
CountryCode: US
TelephoneNumber: 7349369814
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/22/2010
LastUpdateDate: 02/14/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/14/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X125054544ILN Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000X4301107060MIN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RX0202X4301107060MIN Allopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
207RH0000X4301107060MIY Allopathic & Osteopathic PhysiciansInternal MedicineHematology

No ID Information.


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