Healthcare Provider Details

I. General information

NPI: 1356460695
Provider Name (Legal Business Name): FELICIA ANN DAVIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FELICIA ANN DAVIS-FOURTE M.D.

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W HARRISON ST
CHICAGO IL
60612-3714
US

IV. Provider business mailing address

929 E 49TH ST
CHICAGO IL
60615-1805
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-3238
  • Fax: 312-864-9544
Mailing address:
  • Phone: 773-924-1957
  • Fax: 773-924-1984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number036-074543
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: