Provider Demographics
NPI:1528012846
Name:DAVIS, ANN RENEE (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:RENEE
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 1:801 S WASHINGTON ST FL 4
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-7430
Mailing Address - Country:US
Mailing Address - Phone:630-600-0700
Mailing Address - Fax:630-600-0701
Practice Address - Street 1:801 S WASHINGTON ST FL 4
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-7430
Practice Address - Country:US
Practice Address - Phone:630-600-0700
Practice Address - Fax:630-600-0701
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088789207RC0000X
IL036.088789207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
060051327OtherRAILROAD MEDICARE
IL036088789Medicaid
G80913Medicare UPIN
IL502040Medicare ID - Type Unspecified