Provider Demographics
NPI:1093100570
Name:DAVIS, KATHRYN RACHEL (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:RACHEL
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5757 MONCLOVA RD STE 10
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1863
Mailing Address - Country:US
Mailing Address - Phone:419-887-0803
Mailing Address - Fax:419-887-0817
Practice Address - Street 1:5757 MONCLOVA RD STE 10
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537
Practice Address - Country:US
Practice Address - Phone:419-887-0803
Practice Address - Fax:419-887-0817
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.133260208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics