Healthcare Provider Details

I. General information

NPI: 1356579700
Provider Name (Legal Business Name): DAVINA J CROSS D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13105 SCHAVEY ROAD. SUITE 2
DEWITT MI
48820-9014
US

IV. Provider business mailing address

13105 SCHAVEY ROAD SUITE 2
DEWITT MI
48820-9014
US

V. Phone/Fax

Practice location:
  • Phone: 517-668-6166
  • Fax: 517-668-6169
Mailing address:
  • Phone: 517-668-6166
  • Fax: 517-668-6169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC006110
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901002429
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: