Provider Demographics
NPI:1801230966
Name:DAVENPORT, LYNDSI MICHELE (DO)
Entity Type:Individual
Prefix:
First Name:LYNDSI
Middle Name:MICHELE
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LYNDSI
Other - Middle Name:MICHELE
Other - Last Name:MCKINNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:385 N LAPEER RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-3610
Mailing Address - Country:US
Mailing Address - Phone:248-969-7354
Mailing Address - Fax:248-628-8802
Practice Address - Street 1:385 N LAPEER RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-3610
Practice Address - Country:US
Practice Address - Phone:248-969-7354
Practice Address - Fax:248-628-8802
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020244207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine