Healthcare Provider Details

I. General information

NPI: 1912682907
Provider Name (Legal Business Name): CHACE MICHAEL DAVIES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26750 PROVIDENCE PKWY STE 210
NOVI MI
48374-1212
US

IV. Provider business mailing address

26750 PROVIDENCE PKWY STE 210
NOVI MI
48374-1212
US

V. Phone/Fax

Practice location:
  • Phone: 248-465-4469
  • Fax: 248-465-4503
Mailing address:
  • Phone: 248-465-4469
  • Fax: 248-465-4503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number5151016123
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: