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1578583613

NPI Code Detail

MEDICARE: MAXWELL DAVIS MD

MEDICARE: MAXWELL DAVIS MD

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	207P00000X	Emergency Medicine Physician	48659-020	WI
2	207P00000X	Emergency Medicine Physician	036-113273	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000	OTHER	WI	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578583613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAXWELL DAVIS MD

Provider Business Mailing Address
First Line	:	2455 N 124TH ST
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53005-4630
Country	:	US
Telephone Number	:	414-477-1504
Fax Number	:

Provider Business Practice Location Address
First Line	:	2455 N 124TH ST
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53005-4630
Country	:	US
Telephone Number	:	414-477-1504
Fax Number	:

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	01/05/2026

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Directions to “ MAXWELL DAVIS MD” Practice Location

Language	Start Address	Practice Location

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