MEDICARE: MARCI J 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
1	174400000X	Specialist	23001002A	IN

General Provider Information

NPI Number	:	1730463639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCI J DAVIS

Provider Business Mailing Address
First Line	:	405 E HOFFER ST
Second Line	:
City	:	KOKOMO
State	:	IN
Zip	:	46902-2247
Country	:	US
Telephone Number	:	765-457-1553
Fax Number	:	765-457-1553

Provider Business Practice Location Address
First Line	:	405 E HOFFER ST
Second Line	:
City	:	KOKOMO
State	:	IN
Zip	:	46902-2247
Country	:	US
Telephone Number	:	765-457-1553
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2011
Last Update Date	:	10/11/2011

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Directions to “ MARCI J DAVIS ” Practice Location

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