Provider Demographics
NPI:1063451235
Name:DAVIS, MARSHA FLEMING (MD)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:FLEMING
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 W MEQUON RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3264
Mailing Address - Country:US
Mailing Address - Phone:262-242-0700
Mailing Address - Fax:262-242-0710
Practice Address - Street 1:1516 W MEQUON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3264
Practice Address - Country:US
Practice Address - Phone:262-242-0700
Practice Address - Fax:262-242-0710
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35737207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32302500Medicaid
WI370022501OtherRAILROAD MEDICARE
WI000146135Medicare PIN
WI370022501OtherRAILROAD MEDICARE