Provider Demographics
NPI:1356460695
Name:DAVIS, FELICIA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:FELICIA
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:FELICIA
Other - Middle Name:ANN
Other - Last Name:DAVIS-FOURTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:929 E 49TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-1805
Mailing Address - Country:US
Mailing Address - Phone:773-924-1957
Mailing Address - Fax:773-924-1984
Practice Address - Street 1:1901 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3714
Practice Address - Country:US
Practice Address - Phone:312-864-3238
Practice Address - Fax:312-864-9544
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-074543207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG80607Medicare UPIN
ILL66334Medicare ID - Type Unspecified