Provider Demographics
NPI:1922490416
Name:DAVIS, MIRANDA (NPA, CPT)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NPA, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42383 GARFIELD RD UNIT 381286
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-0079
Mailing Address - Country:US
Mailing Address - Phone:313-903-8830
Mailing Address - Fax:586-421-4842
Practice Address - Street 1:42383 GARFIELD RD UNIT 381286
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-7742
Practice Address - Country:US
Practice Address - Phone:844-727-2011
Practice Address - Fax:586-421-4842
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-20
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty