MEDICARE: KEVIN 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	246Z00000X	Other Specialist/Technologist

General Provider Information

NPI Number	:	1508721911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN DAVIS

Provider Business Mailing Address
First Line	:	19346 MIDDLESEX AVE
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-4439
Country	:	US
Telephone Number	:	313-333-1318
Fax Number	:

Provider Business Practice Location Address
First Line	:	19346 MIDDLESEX AVE
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-4439
Country	:	US
Telephone Number	:	313-333-1318
Fax Number	:

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

Provider Enumeration Date	:	12/17/2025
Last Update Date	:	12/17/2025

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Directions to “ KEVIN DAVIS ” Practice Location

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