Healthcare Provider Details

I. General information

NPI: 1134610819
Provider Name (Legal Business Name): EMILY DAVYDOV DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28100 GRAND RIVER AVE STE 314S
FARMINGTON HILLS MI
48336-5967
US

IV. Provider business mailing address

2799 W GRAND BLVD
DETROIT MI
48202-2608
US

V. Phone/Fax

Practice location:
  • Phone: 248-478-1827
  • Fax:
Mailing address:
  • Phone: 313-916-1601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number5101026109
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101023887
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: