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General NPI Number Information
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NPI Number | 1124064225
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Entity Type | Individual
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Provider Name | MICHAEL DAVIS MD
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Gender | Male
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 12010 SHELBYVILLE RD SUITE 400
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City | LOUISVILLE
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State | KY
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Zip | 40243-1054
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Country | US
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Telephone | 502-897-9191
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Fax | 502-897-7626
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Provider Business Mailing Address
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Address Line | PO BOX 950248
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City | LOUISVILLE
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State | KY
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Zip | 40295-0248
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Country | US
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Telephone | 502-489-5730
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Fax | 502-489-5733
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 26497
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License Number State | KY
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