Healthcare Provider Details

I. General information

NPI: 1649631813
Provider Name (Legal Business Name): S PARK-DAVIS HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30880 BECK RD
NOVI MI
48377-1000
US

IV. Provider business mailing address

30880 BECK RD
NOVI MI
48377-1000
US

V. Phone/Fax

Practice location:
  • Phone: 248-926-0009
  • Fax: 248-926-8972
Mailing address:
  • Phone: 248-926-0009
  • Fax: 248-926-8972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUNGNAN PARK-DAVIS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 248-229-0640