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NPI Code Detail

MEDICARE: DR. LISA A DAVIS M.D.

MEDICARE: DR. LISA A DAVIS M.D.
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
1207V00000XObstetrics & Gynecology PhysicianME98623FL
2207V00000XObstetrics & Gynecology Physician036132016IL
3207V00000XObstetrics & Gynecology Physician35.079607OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
230F65OTHERFLBCBS

General Provider Information

NPI Number : 1861462616
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LISA A DAVIS M.D.
Provider Business Mailing Address
First Line : 5666 E STATE ST
Second Line :
City : ROCKFORD
State : IL
Zip : 61108-2425
Country : US
Telephone Number : 815-226-2000
Fax Number :
Provider Business Practice Location Address
First Line : 5666 E STATE ST
Second Line :
City : ROCKFORD
State : IL
Zip : 61108-2425
Country : US
Telephone Number : 815-226-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2006
Last Update Date : 02/06/2026

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