Provider Demographics
NPI:1033287966
Name:DAVICARE HOME MEDICAL SERVICES PC
Entity Type:Organization
Organization Name:DAVICARE HOME MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASUNCION
Authorized Official - Middle Name:
Authorized Official - Last Name:TIDALGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-785-1000
Mailing Address - Street 1:4889 OLD POST CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-3554
Mailing Address - Country:US
Mailing Address - Phone:248-785-1000
Mailing Address - Fax:248-785-1001
Practice Address - Street 1:4889 OLD POST CT
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-3554
Practice Address - Country:US
Practice Address - Phone:248-785-1000
Practice Address - Fax:248-785-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045963207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4284823Medicaid
MIB90623Medicare UPIN
MI0N92810Medicare ID - Type UnspecifiedGROUP PRACTICE