Healthcare Provider Details

I. General information

NPI: 1396132874
Provider Name (Legal Business Name): MCWI, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2816 MANATEE AVE W
BRADENTON FL
34205-4237
US

IV. Provider business mailing address

2816 MANATEE AVE W
BRADENTON FL
34205-4237
US

V. Phone/Fax

Practice location:
  • Phone: 941-744-1200
  • Fax: 941-744-1500
Mailing address:
  • Phone: 941-744-1200
  • Fax: 941-744-1500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME95617
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME95617
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME95617
License Number StateFL

VIII. Authorized Official

Name: DR. CHRISTOPHER J DAVIS
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 941-744-1200