Healthcare Provider Details

I. General information

NPI: 1639092083
Provider Name (Legal Business Name): MICHAEL DAVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1391 WASHINGTON BLVD
PITTSBURGH PA
15206-1801
US

IV. Provider business mailing address

2346 HOLLYWOOD DR
PITTSBURGH PA
15235-2714
US

V. Phone/Fax

Practice location:
  • Phone: 412-661-9222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: