Healthcare Provider Details

I. General information

NPI: 1902947567
Provider Name (Legal Business Name): VERA R DAVIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 183RD ST
TINLEY PARK IL
60477-3690
US

IV. Provider business mailing address

6005 W BUSH CT
MONEE IL
60449-8111
US

V. Phone/Fax

Practice location:
  • Phone: 708-614-3750
  • Fax:
Mailing address:
  • Phone: 312-805-9899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: