Healthcare Provider Details

I. General information

NPI: 1881157238
Provider Name (Legal Business Name): MICAH GREGORY DAVIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 NURSING HOME DR
ARCADIA FL
34266-3870
US

IV. Provider business mailing address

12140 NALL AVE STE 300
OVERLAND PARK KS
66209-2503
US

V. Phone/Fax

Practice location:
  • Phone: 863-993-7717
  • Fax:
Mailing address:
  • Phone: 913-498-6537
  • Fax: 913-498-6708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME157758
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberME157758
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: