Provider Demographics
NPI:1851616197
Name:DEVELLIS, DAVID MOORE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MOORE
Last Name:DEVELLIS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:775 S MAIN ST
Mailing Address - Street 2:ST JOSEPH MERCY CHELSEA HOSPITAL
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1383
Mailing Address - Country:US
Mailing Address - Phone:734-593-5200
Mailing Address - Fax:734-593-5205
Practice Address - Street 1:775 S MAIN ST
Practice Address - Street 2:ST JOSEPH MERCY CHELSEA HOSPITAL
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1383
Practice Address - Country:US
Practice Address - Phone:734-593-5200
Practice Address - Fax:734-593-5205
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2015-02-20
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Provider Licenses
StateLicense IDTaxonomies
MI43011044942084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry