Healthcare Provider Details

I. General information

NPI: 1811556947
Provider Name (Legal Business Name): DAVY BRUNO MACHADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 JOHN R DEPARTMENT OF SURGERY
DETROIT MI
48201
US

IV. Provider business mailing address

AVENIDA PINTO BANDEIRA, 635, AP 903
FORTALEZA CE
60811170
BR

V. Phone/Fax

Practice location:
  • Phone: 313-577-5009
  • Fax: 313-577-5310
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: