Provider Demographics
NPI:1194847947
Name:DAVIS, ALI R (DPM)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 W 109TH ST STE 314
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1315
Mailing Address - Country:US
Mailing Address - Phone:913-364-1314
Mailing Address - Fax:913-364-1160
Practice Address - Street 1:4601 W 109TH ST STE 314
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211
Practice Address - Country:US
Practice Address - Phone:913-364-1314
Practice Address - Fax:913-364-1160
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00354213ES0103X
MO2005015462213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
S87D813Medicare ID - Type Unspecified
V05388Medicare UPIN