Healthcare Provider Details

I. General information

NPI: 1457093817
Provider Name (Legal Business Name): JOHN DAVID DAVIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 S HAGADORN RD STE 520
EAST LANSING MI
48823-6804
US

IV. Provider business mailing address

4660 S HAGADORN RD STE 520
EAST LANSING MI
48823-6804
US

V. Phone/Fax

Practice location:
  • Phone: 517-884-8701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number5101029192
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: