Healthcare Provider Details

I. General information

NPI: 1306831300
Provider Name (Legal Business Name): ARTHUR I DAVIDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 03/26/2012
Certification Date:
Deactivation Date: 03/23/2006
Reactivation Date: 03/29/2006

III. Provider practice location address

105 3RD ST
BLOOMINGDALE IL
60108-1212
US

IV. Provider business mailing address

105 3RD ST
BLOOMINGDALE IL
60108-1212
US

V. Phone/Fax

Practice location:
  • Phone: 630-893-8050
  • Fax: 630-893-8154
Mailing address:
  • Phone: 630-893-8050
  • Fax: 630-893-8154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036070839
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: