MEDICARE: ALEXANDER DAVIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	4704324208	MI

General Provider Information

NPI Number	:	1063952893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER DAVIS

Provider Business Mailing Address
First Line	:	4002 W 13 MILE RD
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-6620
Country	:	US
Telephone Number	:	248-504-8700
Fax Number	:

Provider Business Practice Location Address
First Line	:	4002 W 13 MILE RD
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-6620
Country	:	US
Telephone Number	:	248-504-8700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2017
Last Update Date	:	02/27/2017

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