MEDICARE: MICHAEL CARL DAVIS 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	208M00000X	Hospitalist Physician	4301049534	MI
2	207R00000X	Internal Medicine Physician	4301049534	MI

General Provider Information

NPI Number	:	1811990518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL CARL DAVIS M.D.

Provider Business Mailing Address
First Line	:	1920 LIVERNOIS RD
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48083-1732
Country	:	US
Telephone Number	:	586-431-0222
Fax Number	:

Provider Business Practice Location Address
First Line	:	1920 LIVERNOIS RD
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48083-1732
Country	:	US
Telephone Number	:	586-431-0222
Fax Number	:

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	04/24/2013

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