Provider Demographics
NPI:1598083362
Name:PAUL F. DAVIS, M.D., P.L.C.
Entity type:Organization
Organization Name:PAUL F. DAVIS, M.D., P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-935-5961
Mailing Address - Street 1:1221 SIXTH ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2701
Mailing Address - Country:US
Mailing Address - Phone:231-935-5961
Mailing Address - Fax:231-935-5962
Practice Address - Street 1:1221 SIXTH ST
Practice Address - Street 2:SUITE 303
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2701
Practice Address - Country:US
Practice Address - Phone:231-935-5961
Practice Address - Fax:231-935-5962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPD073182207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4107060Medicaid
MI4107060Medicaid
MI0M78090Medicare PIN