Healthcare Provider Details

I. General information

NPI: 1487095659
Provider Name (Legal Business Name): JARED DAVIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE # MC2030
CHICAGO IL
60637-1447
US

IV. Provider business mailing address

3377 RIVERBEND DR
SPRINGFIELD OR
97477-8803
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-6390
  • Fax:
Mailing address:
  • Phone: 541-222-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number036-142866
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD70054286
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number04-51975
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD227513
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License NumberNCC5557
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: