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General NPI Number Information
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NPI Number | 1699686469
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Entity Type | Individual
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Provider Name | MAXWELL DAVIS FLEMING
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Gender | Male
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Dates
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Enumeration Date | 09/12/2026
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Last Update Date | 09/12/2026
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Provider Practice Location Address
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Address Line | 3630 S 18TH ST
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City | LAFAYETTE
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State | IN
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Zip | 47909-9102
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Country | US
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Telephone | 765-474-3834
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Fax |
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Provider Business Mailing Address
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Address Line | 3204 S 9TH ST APT G
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City | LAFAYETTE
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State | IN
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Zip | 47909-2992
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Country | US
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Telephone | 616-218-3838
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 45025108A
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License Number State | IN
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