MEDICARE: MR. MICHAEL EUGENE DAVIS LCSW, CAADC

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	1041C0700X	Clinical Social Worker	6801089679	MI

General Provider Information

NPI Number	:	1164603163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL EUGENE DAVIS LCSW, CAADC

Provider Business Mailing Address
First Line	:	1426 NE 17TH CT
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33305-3349
Country	:	US
Telephone Number	:	616-848-1918
Fax Number	:

Provider Business Practice Location Address
First Line	:	1426 NE 17TH CT
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33305-3349
Country	:	US
Telephone Number	:	616-848-1918
Fax Number	:

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

Provider Enumeration Date	:	11/19/2007
Last Update Date	:	05/24/2021

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