Healthcare Provider Details

I. General information

NPI: 1811302482
Provider Name (Legal Business Name): DR. MICHAEL DAVITT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1561 CREEKSIDE DR STE 110
FOLSOM CA
95630-3494
US

IV. Provider business mailing address

1561 CREEKSIDE DR STE 110
FOLSOM CA
95630-3494
US

V. Phone/Fax

Practice location:
  • Phone: 916-984-8585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA154906
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: