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NPI Code Detail

MEDICARE: MICHAEL JEWEL DAVIS

MEDICARE: MICHAEL JEWEL DAVIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-23-305255

General Provider Information

NPI Number : 1265203749
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL JEWEL DAVIS
Provider Business Mailing Address
First Line : 4721 S CLIFF AVE STE 103
Second Line :
City : INDEPENDENCE
State : MO
Zip : 64055-6969
Country : US
Telephone Number : 816-608-1956
Fax Number : 800-687-5070
Provider Business Practice Location Address
First Line : 3533 DUNN RD STE 204-212
Second Line :
City : FLORISSANT
State : MO
Zip : 63033-6783
Country : US
Telephone Number : 636-398-2510
Fax Number : 800-687-5070
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2024
Last Update Date : 01/12/2024

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Directions to “ MICHAEL JEWEL DAVIS ” Practice Location

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