MEDICARE: DR. MELISSA ANN DAVIDSON M.D.

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	208000000X	Pediatrics Physician	4301056179	MI
2	207R00000X	Internal Medicine Physician	4301056179	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	156671	OTHER	GREAT LAKES HLTH PLN
2	5551271	OTHER	AETNA PIN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1103904921	OTHER	BCBS
5	110C913020	OTHER	BCBS GRP PIN
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740259332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA ANN DAVIDSON M.D.

Provider Business Mailing Address
First Line	:	4613 W MAIN ST
Second Line	:	SUITE A
City	:	KALAMAZOO
State	:	MI
Zip	:	49006-2645
Country	:	US
Telephone Number	:	269-488-8672
Fax Number	:	269-488-8673

Provider Business Practice Location Address
First Line	:	4613 W MAIN ST
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49006-2645
Country	:	US
Telephone Number	:	269-488-8672
Fax Number	:	269-488-8673

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	11/27/2023

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Directions to “ DR. MELISSA ANN DAVIDSON M.D.” Practice Location

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