Provider Demographics
NPI:1407000482
Name:DAVIS, BIRGIT III
Entity type:Individual
Prefix:
First Name:BIRGIT
Middle Name:
Last Name:DAVIS
Suffix:III
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 WABASH CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-8413
Mailing Address - Country:US
Mailing Address - Phone:260-224-5281
Mailing Address - Fax:
Practice Address - Street 1:504 WABASH CIR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-8413
Practice Address - Country:US
Practice Address - Phone:260-224-5281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200911410 AMedicaid