Provider Demographics
NPI:1891777140
Name:DAVIS, MARC (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-583-0660
Mailing Address - Fax:989-583-0669
Practice Address - Street 1:16440 GRATIOT RD
Practice Address - Street 2:
Practice Address - City:HEMLOCK
Practice Address - State:MI
Practice Address - Zip Code:48626-8655
Practice Address - Country:US
Practice Address - Phone:989-583-0660
Practice Address - Fax:989-583-0669
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301073514207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI204068OtherHEALTH ADVANTAGE NETWORK
MI5981692OtherAETNA
MI080D410020OtherBLUE CHOICE
MIF85987OtherHEALTH NET FEDERAL SERVIC
MI080D410020OtherBLUE CARE NETWORK
MI0984691OtherHEALTH PLUS
MI3527328Medicaid
MI0804400401OtherBLUE CROSS BLUE SHIELD
MI080D410020OtherBLUE CROSS BLUE SHIELD
MI204068OtherMCLAREN HEALTH PLAN
MIF85987OtherHAP
MI080D410020OtherCOMMUNITY BLUE
MIC7488OtherMCARE
MI204068OtherHEALTH ADVANTAGE NETWORK
MI3527328Medicaid