Provider Demographics
NPI:1033683263
Name:DAVIS, AARON MICHAEL (RDN)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:MICHAEL
Last Name:DAVIS
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4946 LEWISTON DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-7101
Mailing Address - Country:US
Mailing Address - Phone:765-729-3735
Mailing Address - Fax:
Practice Address - Street 1:1305 N TILLOTSON AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-2948
Practice Address - Country:US
Practice Address - Phone:317-286-6607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86112844133V00000X
IN133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN83-3238435Medicaid
IN38016888410Medicaid