Provider Demographics
NPI:1598258105
Name:DAVISON MEDICAL PRACTICE PLC
Entity Type:Organization
Organization Name:DAVISON MEDICAL PRACTICE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALWA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMEDAHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-877-2088
Mailing Address - Street 1:1260 N IRISH RD STE B
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-2276
Mailing Address - Country:US
Mailing Address - Phone:810-653-0899
Mailing Address - Fax:810-653-4144
Practice Address - Street 1:1260 N IRISH RD STE B
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423
Practice Address - Country:US
Practice Address - Phone:810-653-0899
Practice Address - Fax:810-653-4144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-08
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4301090589OtherLICENSE NUMBER