Provider Demographics
NPI:1588824833
Name:DAVIDSON, AUTUMN (MD)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:DAVIDSON
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 1:820 S WOOD ST
Mailing Address - Street 2:M/C 808
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4325
Mailing Address - Country:US
Mailing Address - Phone:312-996-5994
Mailing Address - Fax:312-996-4238
Practice Address - Street 1:820 S WOOD ST
Practice Address - Street 2:M/C 808
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4325
Practice Address - Country:US
Practice Address - Phone:312-996-5994
Practice Address - Fax:312-996-4238
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036130015207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology