Healthcare Provider Details

I. General information

NPI: 1487677233
Provider Name (Legal Business Name): CHERRICA T DAVIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29804 LAKESHORE BOULEVARD
WILLOWICK OH
44095
US

IV. Provider business mailing address

PO BOX 781389
DETROIT MI
48278-1389
US

V. Phone/Fax

Practice location:
  • Phone: 440-833-2095
  • Fax: 440-833-2096
Mailing address:
  • Phone: 440-953-6082
  • Fax: 440-953-6101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number35-084193
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-084193
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-084193
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: