Healthcare Provider Details

I. General information

NPI: 1750364642
Provider Name (Legal Business Name): DEBRA DARLENE DAVIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 W 161ST ST # A
WESTFIELD IN
46074-9623
US

IV. Provider business mailing address

218 W 161ST ST # A
WESTFIELD IN
46074-9623
US

V. Phone/Fax

Practice location:
  • Phone: 317-582-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01039356A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: