Healthcare Provider Details

I. General information

NPI: 1881431096
Provider Name (Legal Business Name): DEVIN MICHAEL DAVIES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST STE 1106
CHICAGO IL
60612-3845
US

IV. Provider business mailing address

1725 W HARRISON ST STE 1106
CHICAGO IL
60612-3845
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number125.087919
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: