Dr Daeryl Dave Elgincolin Amponin, MD is a medicare enrolled "Emergency Medicine" physician in Lanse, Michigan. His current practice location is
18341 Us Highway 41, Lanse, Michigan. You can reach out to his office (for appointments etc.) via phone at
(906) 524-3300.
Dr Daeryl Dave Elgincolin Amponin is licensed to practice in Michigan (license number 4351050910) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1093419301.
Physician's Profile
| Full Name | Dr Daeryl Dave Elgincolin Amponin |
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| Gender | Male |
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| Speciality | Emergency Medicine |
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| Location | 18341 Us Highway 41, Lanse, Michigan |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1093419301
- Provider Enumeration Date: 03/29/2023
- Last Update Date: 06/30/2026
Medicare PECOS Information:
- PECOS PAC ID: 7214397512
- Enrollment ID: I20230718003638
Medical Identifiers
Medical identifiers for Dr Daeryl Dave Elgincolin Amponin such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
| 1093419301 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
| 207P00000X | Emergency Medicine | 4351050910 (Michigan) | Primary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Daeryl Dave Elgincolin Amponin is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
Dr Daeryl Dave Elgincolin Amponin, MD 18341 Us Highway 41, Lanse, MI 49946-8024 Ph: (906) 524-3300 | Dr Daeryl Dave Elgincolin Amponin, MD 18341 Us Highway 41, Lanse, MI 49946-8024 Ph: (906) 524-3300 |
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