Healthcare Provider Details

I. General information

NPI: 1245894476
Provider Name (Legal Business Name): AUSTIN CHRISTOPHER DAVIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20901 MOROSS RD
DETROIT MI
48236-2058
US

IV. Provider business mailing address

559 W GRAND BLVD
DETROIT MI
48216-2200
US

V. Phone/Fax

Practice location:
  • Phone: 313-626-2600
  • Fax: 313-626-2605
Mailing address:
  • Phone: 313-554-0485
  • Fax: 313-228-0283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101026838
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: